The design of “TeamBirth”: A care process to improve communication and teamwork during labor

Abstract

Background: Despite evidence that communication and teamwork are critical to patient safety, few care processes have been intentionally designed for this purpose in labor and delivery. The purpose of this project was to design an intrapartum care process that aims to improve communication and teamwork between clinicians and patients. Methods: We followed the "Double-Diamond" design method with four sequential steps: Discover, Define, Develop, and Deliver. In Discover, we searched professional guidelines and peer-reviewed literature to delineate the challenges to quality of intrapartum care and to uncover options for solutions. In Define, we convened an interdisciplinary group of experts to focus the problem scope and prioritize solution features. In Develop, we created initial prototype solutions. In Deliver, we engaged clinicians and patients in rapid cycle testing to iteratively produce a care process called "TeamBirth" that aims to improve team communication. Results: We designed TeamBirth, an intrapartum care process composed of brief team meetings ("huddles") between clinicians and patients. Huddles are navigated by a shared planning board placed in the labor and delivery room in view of the patient and their care team. The board promotes transparent and reliable communication and contains four areas to be acknowledged or discussed: (a) the names of the team members, starting with the patient; (b) the patient's preferences; (c) the care plan for the patient, baby, and labor progress; and (d) when the next team huddle is anticipated. Discussion: We identified an opportunity to improve the safety and dignity of childbirth care through an intrapartum care process that promotes reliable and structured communication and teamwork. Future work should evaluate the acceptability and feasibility of implementation and potential impact on safety and experience of care.

Implementation strategies within a complex environment: A qualitative study of a shared decision‐making intervention during childbirth

“…The planning board is a dry erase board present in every labor room that structures essential information, which includes the names of the full care team, the birthing person's preferences, care plans, and expectations for when the team will come together again (Appendix S1). 32 Huddles are structured full care team meetings that occur in the birthing person's room at key moments throughout labor, but most importantly on admission, when the care plan is discussed before clinical decision‐making. The number of huddles each birthing person experiences is determined by their course of labor.…”

Updates from the Literature, November/December 2021

“…1,2 Misclassification worsened with age with the worst being among people older than 40 years. 3,4 To address this, the authors used a set of confirmed maternal deaths to reexamine age-related instances of maternal mortality in the United States and identify the leading causes of death. 5 As a result of issues with the pregnancy checkbox, the authors recoded data so that only death certificates where pregnancy or the postpartum were written in (vs only in a checkbox) were coded as having maternal causes for death.…”

“…The third article offers a possible solution for making clinical decisions in a manner that prioritizes patient preference. 3 All of these articles share an interest in cesarean birth as an outcome.…”

“…This article describes the creation of TeamBirth, which is essentially a series of regular huddles between clinicians and patients during the birth process that use a white board in the patient room. 3 The white board includes the name of the team members; the patient's preferences; the care plan for the patient, fetus, and labor progress; and the next anticipated huddle time. 3 The authors note that most sentinel events in perinatal care have failures of communication and teamwork at their root.…”

“…3 The white board includes the name of the team members; the patient's preferences; the care plan for the patient, fetus, and labor progress; and the next anticipated huddle time. 3 The authors note that most sentinel events in perinatal care have failures of communication and teamwork at their root. Their purpose was to use design thinking methodology to produce a scalable, intrapartum care process to improve communication and teamwork in order to address harmful variation in the quality of childbirth care.…”