Ensuring maternal safety is a patient safety priority. This library reflects a curated selection of PSNet content focused on improving maternal safety. Included resources explore strategies with the potential to improve maternal care delivery and outcomes, such as high reliability, care standardization, teamwork, unit-based safety initiatives, and trigger tools.
In this PSNet Annual Perspective, we review key findings related to improvement strategies when communicating with patients and different structured communication techniques to improve communication across providers. Lessons learned from innovative approaches explored under COVID-19 that could be considered as usual care resumes are also discussed.
Zheng F ed. Surg Clin North Am. 2021;101(1):1-160.
Multidisciplinary teams at the University of Kansas Hospital sought to improve patient outcomes from obstetric emergencies by rehearsing team responses in simulations to emergent situations that can occur during a delivery. Using the PRactical Obstetric MultiProfessional Training (or PROMPT) curriculum, teams rehearsed flexible emergency care scenarios in order to achieve an optimal response, and then used this experience to improve their response to a real emergency. The PROMPT program requires the participation of all healthcare providers who might be called on to manage a pregnant women and is repeated annually. Over the eleven years the program was employed at the University of Kansas Hospital, there was a progressive reduction in the rates of cesarean delivery, brachial plexus injury (transient and permanent), and hypoxic ischemic encephalopathy at term, low umbilical artery pHs, decision-to-delivery times for fetal distress, the need for blood transfusion. The rate of shoulder dystocia was relative stable. These improvements are consistent with both RCTs and case control studies conducted worldwide evaluating the PROMPT program. In 2018, institutional priorities at the University of Kansas Hospital shifted and the team transitioned away from using PROMPT as their training model. However, PROMPT training is implemented widely internationally and is available in North America from PROMPT North America. Other organizations in the United States implementing PROMPT include University of Washington M.C., Baylor Scott & White University Medical Center, and Redington Fairview General Hospital, among others. Participant course materials can be purchased from Cambridge University Press and on Amazon.
This piece discusses the concept of Safety Across the Board and reviews the three key components necessary for successful implementation in a healthcare organization: culture, strong safety processes, and engagement.
Edwin Loftin, DNP, MBA, RN, NEA-BC-FACHE is the Senior Vice President of Integrated and Acute Care Services and the Chief Nursing Officer (CNO) at Parrish Medical Center in Titusville, Florida. We spoke with him about his experiences with the concept of safety across the board at his medical center.
Social worker/nurse practitioner teams collaborate with a larger interdisciplinary team and primary care physicians to develop and implement individualized care plans for seniors and other high-risk patients. The social worker/nurse practitioner team also proactively manages and coordinates the patient's care on an ongoing basis through regular telephone and in-person contact with both patients and providers. The program, known as Geriatric Resources for Assessment and Care of Elders (GRACE), improved the provision of evidence-based care; led to significant improvements in measures of general health, vitality, social functioning, and mental health; reduced emergency department visits, hospital admissions, readmissions, and total bed days; and generated high levels of physician and patient satisfaction. These successes have been across a variety of health system contexts, including: a VA medical center, primary care health centers, and as a part of a Medicare Advantage plan. A recent analysis found that the reduction in service usage saved the VA medical center $200k per year for the 179 veterans enrolled in GRACE. Another analysis in primary care health centers found that the program was cost neutral for high-risk patients in the first 2 years, and yielded savings by year 3.
The program was initially designed to serve low-income seniors, but has subsequently been replicated with different populations, including adults of all ages who are high risk, Medicare beneficiaries who are 70+ with multiple comorbidities, and older veterans following an emergent hospital admission and discharge home.