Recently, Lorraine Parker, Patient Care Administrator at Winnie Palmer Hospital for Women and Babies in Florida presented a safety program for perinatal care that was recently implemented at her organization as part of joint venture with Duke University and the Agency for Healthcare Research and Quality (AHRQ). She explained how Relias OB (formerly GNOSIS for OB) was a component of the blended learning model in the program. Understanding that you can’t improve what you don’t measure, they also relied on Relias analytics to establish baseline metrics.
As she outlined the program, Lorraine focused on three things to consider when implementing a perinatal safety program.
1. Train for communication
Part of the program was based on TeamSTEPPS, an evidence-based set of teamwork tools aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.
Originally designed for the airline industry, the framework “focuses on communication, standardization and tools so the team can play from the same playbook,” according to Lorraine. She also stressed how important it is that all players are speaking the same language, especially in labor and delivery.
She cited the example of a nurse communicating with a provider who was in the doctor’s lounge finishing a coffee. She called to ask him to look at a tracing, but did not convey the urgency she intended. The doctor finished his coffee and returned to the unit to look at the tracing. He entered to find a STAT C-Section with AGPARS not what they would have wanted. Lorraine said this, and the possibilities of more incidents like this, was the catalyst for joining the joint venture with AHRQ.
2. Structure for Teamwork
According to Lorraine, the key in building a culture of safety among a team is starting locally in each unit. They opted to begin in Labor and Delivery understanding that components which are important to them, may have different prioritization in another unit.
And in that unit they made sure everyone was trained from the provider to the housekeepers to build a shared mental model. Lorraine said, “It’s important that the quality improvements are things that matter to that team.”
They used standardized training and evidence-based education, but also focused on a Comprehensive Unit Based Approach (CUSP) that is tailored to the unit and where quality improvement initiatives are individualized. When you include everyone on the team you encourage a shared mental model. Lorraine explained, “When these things are happening, when there is a significant event, it really helps everyone jump into action for the same reasons.”
3. Focus on Opportunities
In obstetrics where adverse events are low volume, but high significance, building a culture of safety is critical to achieving quality care. Lorraine demonstrated how she uses Relias data to identify the knowledge gaps that represent the areas of opportunity for education and training.
After analyzing the team variation, her team focused on EFM and OB emergency and ways that they could increase knowledge and judgment skills in those areas. For example, data suggested the team needed more practice with interpreting level II tracings; practice they received on Relias and in instructor-led training. Lorraine said, “We knew we had gaps and we needed to fill them.”
She also implored how clinical knowledge and judgement is important for the team regardless of role. She used the example of providers having a better understanding of why nurses were weighing sponges and what that meant in regards to their improvement metrics as a unit.
The highlight of the webinar was a report on improvement metrics.
Lorraine explained how they used the AHRQ survey to measure success. In these metrics, the results showed significant improvement in key performance indicators such as “teamwork in units”, where the unit increased from the 75th percentile to the 90th percentile. And in 4 meaningful areas they moved from below the national average to exceeding the national average.
Lorraine also showcased several other key improvement measurements in clinical outcomes including:
- Winnie Palmer experienced an approximated 7% decrease in their Modified Adverse Outcome Index upon completion of the program.
- One component of this Index, the Unanticipated Operative Procedure measure, decreased by 51%.
- The AHRQ Patient Safety Indicator 18 (Obstetric Trauma –Vaginal Delivery with Instrument) decreased by 32%
These results will be published in an upcoming AHRQ publication.