Comprehensive Perinatal Safety Initiative to Reduce Adverse Obstetric Events

Abstract

A comprehensive perinatal safety initiative (PSI) was incrementally introduced from August 2007 to July 2009 at a large tertiary medical center to reduce adverse obstetrical outcomes. The PSI introduced: (1) evidence-based protocols, (2) formalized team training with emphasis on communication, (3) standardization of electronic fetal monitoring with required documentation of competence, (4) a high-risk obstetrical emergency simulation program, and (5) dissemination of an integrated educational program among all healthcare providers. Eleven adverse outcome measures were followed prospectively via modification of the Adverse Outcome Index (MAOI). Additionally, individual components were evaluated. The logistic regression model found that within the first year, the MAOI decreased significantly to 0.8% from 2% (p<.0004) and was maintained throughout the 2-year period. Significant decreases over time for rates of return to the operating room (p<.018) and birth trauma (p<.0022) were also found. Finally, significant improvements were found in staff perceptions of safety (p<.0001), in patient perceptions of whether staff worked together (p<.028), in the management (p<.002), and documentation (p<.0001) of abnormal fetal heart rate tracings, and the documentation of obstetric hemorrhage (p<.019). This study demonstrates that a comprehensive PSI can significantly reduce adverse obstetric outcomes, thereby improving patient safety and enhancing staff and patient experiences.

What is the impact of multi-professional emergency obstetric and neonatal care training?

“…Three studies reported on the decrease of birth trauma after training, one unspecified [60] and two on brachial plexus injury [34,44]. An abstract on an Americanised PROMPT study not included in our review also reported significant reductions in brachial plexus injuries and perinatal HIE [80].…”

“…Thirteen studies had been conducted in [19][20][21][22][23][24][25][26][27][28] 6 DH (L2&L3) -HIC 10 RCT 2a,b,c 3b NHS Foundation Trust, Liverpool, UK [44,45] --HIC 1 Before-after 4b,c Victoria, Australia [46] 7 [48] --LMIC 1 Before-after 1 2b −−− −−− Sub-Saharan Africa (7 countries) [49] --LMIC 1 Before-after 1 2b,c −−− −−− Somaliland, Somalia [50] 3 8 LMIC 1 Before-after 1 2b,c 3a 4b Making it Happen, Bangladesh & India [52] 4 DH (Bangl.) [54] 3 DH; 3 FH 40 LMIC 1 Quasi-experimental 3c CRM based National study, US [58] 15 -HIC 1 RCT 4c Beth Israel Deaconness Medical Center, US [59] 1 TTH -HIC 1 Before-after 2a 4b,c Perinatal Safety Initiative, US [60] 1 TH -HIC 1 Before-after 3a 4b,c Rhode Island Hospital, US [61] 1 -HIC 1 Before-after 4b,c Geneva University Hospital, Switzerland [63] 1 TTH -HIC 1 Before-after 1 2a 3a TeamSTEPPS, US [18] 3 CH -HIC 1 RCT 2a 4c OBCTT, Southeast US [62] 1 TTH -HIC 1 Quasi-experimental before-after 1 2a,b,c −−− −−− OTHER CEmONC, Tanzania [17] 1 DH LMIC 1 Before-after 3c Copenhagen University Hospital, Denmark [64] 1 TTH -HIC 1 Before-after 1 2a,b 3a 4b University of Oporto, Portugal [65] 1 TTH -HIC 1 Before-after 1 2b 3a * In progress -abstracts not included [31,32] DH = district hospital L1 = level 1 −−− = studies not going beyond Kirkpatrick level 2 RH = referral hospital L2 = level 2 (secondary/regional) FH = field hospital TH = tertiary hospital/medical centre L3 = level 3 (tertiary) CH = community hospital TTH = tertiary and teaching hospital included in the studies spans the whole spectrum from tertiary teaching hospitals to community-and field hospitals. Three LMIC studies included community health centres.…”

“…Four studies reported the maternal and neonatal outcomes in a more holistic way by the use of an Adverse Outcomes Index (AOI) [58, 59,61] or a modified AOI [60] with weighted maternal and neonatal indicators or outcomes to measure the impact of a programme associated with training. The only RCT using a CRM approach did not show a significant difference in the AOI between the intervention and control hospitals, possibly because of the short time frame for conducting the trial and assessing the impact [58] or because it was not simulation based [79].…”

Evidence of Linkages between Patient Safety and Person-Centred Care in the Maternity and Obstetric Context—An Integrative Review

“…It was possible to interpret guidelines for patient risk assessment [33], to improve PS multicomponent safety initiatives in the healthcare system [35] [39], enhance approaches to communication [38], share experiences by debriefing [40], team training [41], standardized documentation [42] and analysis of claim files to identify opportunities for improvement [44]. In summary, the perspectives of patients [33] Table 2.…”

“…Convergent validity of the scale scores was measured by correlations with external teamwork related items [34]. The study by Wagner et al [35] used logistic regression. In summary, the most common weaknesses of the included studies related to design, sampling and analysis.…”