10 Nov

Impact of the laborist model on obstetric care

Research Summary:
Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes*

Inventor of PeriGen advanced fetal monitoringBy Emily Hamilton, MD CM, Senior Vice President of Clinical Research

This study, published in the August 13th issue of the American Journal of Obstetrics & Gynecology, examines outcomes before and after the introduction of a laborist model of care. Surprisingly, very few differences were noted when comparing changes over time in the hospitals with laborists to changes over the same period of time in the matched hospitals without laborists. This paper describes an interesting methodology to try and tease apart the effect of various factors on obstetrical outcomes. This is relevant because most quality improvement initiatives are studied in a before-and-after fashion and not in a prospective randomized trial.

The study is discharge summary data to NPIC between 1998 and 2011. Results from three hospitals where laborists were introduced were compared to six control hospitals matched for delivery volume, geographical area, teaching hospital status and level of neonatal nursery.

Once adjustment was made for several patient-related factors, no differences were observed in the odds ratio (OR) for any of the neonatal outcomes or for cesarean rates. The OR was reduced only for induction of labor (0.85 95%CI 0.71-0.99) and for Preterm Birth (0.83 95%CI 0.72-0.96). Although the OR for Preterm Birth was reduced this was not accompanied by a change in the OR for the birth of babies weighing

In short, the introduction of laborists was associated with a change in medical behavior (Induction of labor) and some change in actual outcome (preterm births), but not in low-birth-weight babies. A question that springs to mind immediately is the role of unmeasured factors such as policies to curtail elective induction of labor prior to 39 weeks that became common during this timeframe and were not adopted by all hospitals at the same time. Evidently the desire to improve is alive and well in many hospitals and there is no single solution for all.

Reference:
*Srinivas SK, Small DS, Macheras M, Hsu JY, Caldwell D, Lorch S. Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes. Am J Obstet Gynecol. 2016 Aug 13. https://www.ncbi.nlm.nih.gov/pubmed/27530491

27 Sep

Telemedicine Branching Out to Smallest Patients

By Matthew Sappern, CEO, PeriGen

Remote communication in obstetricsTelemedicine is getting much attention these days as innovative health systems look to increase operational efficiency and patient satisfaction. Leaders such as Stephen Klasko, MD at Thomas Jefferson University Hospital are mandating telemedicine and this top down approach will surely accelerate adoption.

Telemedicine is quickly moving beyond telestroke and the ICU. At least one major EMR company and one of the nation’s leading health systems – fortunately a PeriGen client – are investing significant resources to bring telemedicine to labor and delivery. Complexity, risk and attrition in the ranks of OBs and MFMs make labor and delivery an ideal service line in which to deploy these technologies. PeriGen’s fetal surveillance platform uses Artificial Intelligence to identify troubling patterns and long-term trends in fetal strips. This real time capability is now at the heart of a telemedicine infrastructure which allows a single OB to be alerted to specific cases – showing patterns identified as the most troubling – across an entire health system.

Telemedicine branching out to smallest patients
As a standalone tool or in concert with the above-mentioned EMR module, telemedicine creates a cost-effective way to leverage valuable clinical resources across an enterprise and help safeguard one of a health system’s most risky and most valuable service lines.

29 Jul

Trending in OB

Telehealth in labor & deliveryTelemedicine Branching Out to the Smallest Patients

Telemedicine is getting much attention these days as innovative health systems look to increase operational efficiency and patient satisfaction. Leaders such as Stephen Klasko, MD at Thomas Jefferson University Hospital are mandating telemedicine and this top down approach will surely accelerate adoption.

Telemedicine is quickly moving beyond telestroke and the ICU. At least one major EMR company and one of the nation’s leading health systems – fortunately a PeriGen client – are investing significant resources to bring telemedicine to labor and delivery. Complexity, risk and attrition in the ranks of OBs and MFMs make labor and delivery an ideal service line in which to deploy these technologies. PeriGen’s fetal surveillance platform uses Artificial Intelligence to identify troubling patterns and long-term trends in fetal strips. This real time capability is now at the heart of a telemedicine infrastructure which allows a single OB to be alerted to specific cases – showing patterns identified as the most troubling – across an entire health system.

As a standalone tool or in concert with the above-mentioned EMR module, telemedicine creates a cost-effective way to leverage valuable clinical resources across an enterprise and help safeguard one of a health system’s most risky and most valuable service lines.

I’d love to hear how your meeting the twin challenges of improving patient safety and the expected shortage of labor & delivery providers.

 

28 Jul

Part 1: Perinatal Nursing & Technology

Rebecca Cypher, PeriGen Chief Nursing OfficerTechnologies in Perinatal Nursing:
Time to Accept & Embrace the Challenge

by Rebecca Cypher, MSN, PNNP
Chief Nursing Officer, PeriGen, Inc.

I wanted to share with you a white paper that PeriGen asked me to prepare on how today’s healthcare technologies can help us in perinatal nursing. Since the paper is lengthy and few of us have time to read such articles in one sitting, I’ve split the paper into three parts and will deliver it to you via email and PeriGen’s social media platforms (Facebook, LinkedIn, Twitter) over the next several weeks. If, by chance, you would like the full article, click here for access to the PDF

Let’s start with a look back at where we’ve come from:

Humans have a long history of inventing tools to survive and achieve goals more efficiently.1 Some tools survive the test of time and evolve while others are abandoned. Healthcare is no different. Monitoring devices and healthcare information technologies (HIT) are key tools used in modern healthcare and time will tell how well they advance as healthcare changes.

Perinatal Nursing Technology-Figure 1Perinatal nursing is just one example of where HIT has had a significant influence on integrating technology with a nursing process framework. 3 Monitoring technology, information technology and clinical acumen can be thought of as an interdependent hierarchy. (See Figure 1 above ). For example, at the most basic level, electronic fetal monitor (EFM) sensors measure fetal heart rates (FHR) and uterine activity. At an intermediate level, HIT consolidates and analyzes the monitoring data for clinicians. At the highest level, nurses decide what the data means, what is likely to happen next and implement the most beneficial interventions. Each level depends, in part, upon the former. Historically, nurses did everything including auscultating FHRs with a fetoscope, palpating uterine activity, recording data in a paper record, and made FHR decisions based on what could be heard and recorded. Now EFM and software accomplish several of these tasks. For some nurses, these new technologies evoked insecurity, a feeling that professional value and roles would be diminished. For others, new technology provided a release from endless listening, counting and transcribing and consequently freeing time to focus on clinical judgment and hands on patient care. In fact, while fetal monitors did reduce the counting tasks they also elevated the expectation for medical reasoning or tracing interpretation.

The purpose of this document is to broadly outline the evolution in each of the three levels of data collection via monitors, interpretation and clinical intervention. In addition, we will discuss relative strengths and weakness of clinicians and HIT in the context of modern perinatal care and how they complement each other.

Clarity on this subject is important to:

  1. Emphasize that clinical acumen for diagnostic and therapeutic decisions and compassionate care is paramount
  2. Determine where and why technology can be a help or a hindrance for nurses
  3. Provide guidance for designers of new technology to meet a nurse’s greatest clinical need

Monitoring Technology

By 2004, 89% of births in the United States were monitored electronically. 4 In view of the high and stable rate of electronic monitoring Vital Statistics ceased reporting EFM utilization rates in annual birth-related reports. Monitoring sensors and signal processing have evolved to provide excellent measurement of FHR, uterine activity and maternal vital signs. 5 Fetal monitors can indicate signal coincidence when two sources of heart rate measurement are the same. On the other hand, monitoring faces new physical challenges. Obesity impedes monitoring by Doppler ultrasound based external sensor technology.

Given the imprecise relationship between FHR and fetal brain oxygenation or acid- base status, a considerable effort has been devoted to finding other physiological measures that would be more discriminating. Unfortunately, prospective clinical trials show no clinical benefit in using EFM with additional sensors that measure fetal oxygen saturation or fetal ST segments of the fetal ECG compared to using EFM alone. 6, 7 Thus, for the near future, the obstetrical world remains dependent upon standard EFM.

Healthcare Information Technology

HIT has evolved considerably in contrast, to the relative stagnation of the monitoring devices. Early electronic medical records allowed clinicians to collect, display and store information in a legible fashion, but at considerable inefficiency. Data entry was often arduous, time-consuming and error -prone. “Cut and paste” shortcuts led to nonsense entries with costly legal repercussions. Lack of interoperability wasted time with redundant documentation.

Perinatal nurses have played an important role in this evolution. Working alongside HIT experts, nurses have been vital members of multidisciplinary teams in which integrating, implementing, and maintaining fetal surveillance technologies with clinical practice has become a priority in patient centered care and safety. This is especially apparent in organizations that promote high reliability units.

There has been considerable industry consolidation on a few types of hospital-wide electronic medical records boosting interoperability. IT networks, smartphones and cloud-based computing give nurses unprecedented and speedy access to information and human expertise. The computational power and reliability of basic computers and networks means very complex analytical methods can be available in real-time at the bedside. 8, 9 Computerized analyses can now be applied to EFM tracings or evaluate labor progression to bring consistent interpretation, reducing clinical variation.

Psychological testing has underlined the importance of simplicity and clarity of information displayed on computer screens. Overcrowded or confusing displays can lead to medical error. Better graphical designs mean critical information is consolidated for efficient review by clinicians. High rates of false alarms lead to frustration and disregard of the device. Truly discriminating alerts based on better evidence-based algorithms alleviate this alarm fatigue.

To continue reading this article or review the references, please click here

05 Apr

Annual Obstetric Malpractice Review

Lowering malpractice outlays & reservesEvery year, according to a study published by The New England Journal of Medicine in 2011, just over 11% of obstetricians and the hospitals and clinicians serving them, will be faced with malpractice complaints. The average payout will be approximately $360,000 with significant state-by-state variation.¹

PeriGen’s Annual Review of
Labor & Delivery Malpractice Awards

Following is a summary of 2015 perinatal malpractice awards, settlements and complaints:

    • $8.4 Million Awarded for Hypoxic Ischemic Brain Injury:   Mother was admitted to the a Georgia medical center for delivery of a full-term baby. The labor continued throughout the evening.  Baby was delivered around noon the next day. Her admitting physician was not present at the delivery, but delivery was overseen by a CNM. For several hours prior to the delivery, fetal heart rate was noted as decelerating and variable. Infant was born severely depressed, with low APGAR scores and metabolic acidosis. He was not intubated for 8 minutes, and he continued to deteriorate, a full code ensued, and resuscitation occurred. Ultimately, infant was diagnosed with a hypoxic ischemic brain injury and developed cerebral palsy. Click for details
    • A Michigan court granted the right to appeal for a case stemming from a 2008 delivery outcome.  Mother  was admitted to the hospital with ruptured membranes. She had a lengthy labor – 29 hours – augmented by the drug Pitocin.  The baby failed to descend after two hours of pushing. The mother had developed chorioamnionitis (placental infection) and the doctors noticed the presence of meconium. The labor was terminated with a caesarian section. Records revealed “delivery of a healthy baby boy who weighed 9 lbs 13 oz. However, the infant began to show signs of seizing shortly after his birth and a CT scan revealed an acute left middle cerebral artery ischemic stroke, which was “days to hours old.” The complaint alleged that “[t]he baby was at risk for, and did develop, brain injury from traumatic head compression and regional cerebral ischemia caused by failure to descend, macrosomia (large baby), excessive contractions in the presence of failure of descent as augmented with oxytocin, hypoxia-ischmeia (regional cerebral and/or systemic) caused by uteroplacental insufficiency and by cord compression and head compression.” The complaint alleged that defendants were negligent in administering oxytocin, in failing to properly respond to fetal heart rate changes, and in failing to perform a timely c-section. Click for details
    • A couple in Puerto Rico filed a suit for $27 million against two hospitals as a result of respiratory failure, perinatal asphyxia, and clinical sepsis. After experiencing pelvic pressure and secretions the mother was admitted without contractions or amniotic rupture. The mother underwent induced labor. Upon birth, the newborn was found  to be in critical condition. His skin was blue from poor circulation, and he did not respond to any external stimuli.  The boy was rushed to NICU and hooked up to a mechanical ventilator. He was diagnosed with respiratory failure, perinatal asphyxia, and clinical sepsis. After nearly a month of care, the boy was released from treatment. Then in January 2013 doctors diagnosed him with multicystic leukoencephalopathy and microcephaly, from which stemmed a host of motor, mental, and sensory complications, such as seizures and impaired vision and hearing. Click to review case
    • A New Jersey family realized a $700,000 malpractice settlement as a result of a Erbs palsy brachial plexus injury.  The case contends that the attending physician used excessive traction during  delivery, resulting in stretching and tearing of the brachial plexus. See details
    • Another settlement, this one for $562,500 followed a complaint that the obstetrician and nurse, monitoring a patient in labor, failed to recognize that the infant’s heart rate had slowed when the fetal monitor strips was actually demonstrating the mother’s heart rate. The mother’s uterus had abrupted, causing a lack of blood flow and oxygen to the baby. By the time the error was recognized, the infant had died from lack of oxygen.  Details provided here
    • Hypoxic ischemic encephalopathy (HIE) with extensive brain injury is the subject of a recent medical malpractice claim brought against a military hospital in the District of Columbia. The complaint states that after being admitted to the medical center in the early stages of labor, the plaintiff was given oxytocin to help augment contractions. Subsequent fetal heart monitoring suggested an abnormally high rate of contractions, but augmentation was continued. Following this, medical records indicated an increase in the fetal heart baseline along with intermittent late decelerations. Shortly thereafter, the mother developed a fever and was diagnosed with chorioamnionitis (a bacterial infection of the fetal membranes). After several hours of prolonged labor, the plaintiff was delivered, at which point shoulder dystocia was noted.  Allegedly, a first year resident then unsuccessfully attempted to relieve the shoulder dystocia with downward pressure. Next, a third-year resident tried several maneuvers to free the baby’s shoulder, including the McRoberts maneuver, the Rubin maneuver and others. All were ineffective. At this point, contends the complaint, the attending obstetrician arrived and was able to successfully free the shoulder allowing for a vaginal delivery. Upon delivery, the plaintiff’s little girl was was described as having bruising on the face and scalp, a fractured right clavicle and Erb’s palsy. She was also hypotonic and experienced seizures. About five days after her birth an MRI revealed that the child showed hypoxic ischemic encephalopathy with extensive brain trauma. See more
    • Honolulu based hospital faced with $9,000,000 obstetric settlement:  The mother arrived at the hospital at 35 weeks into her pregnancy, she had severe lower abdominal pain. Because of her previous history of miscarriage and the complicated delivery of her first child, the mother had undergone a procedure to keep her uterus closed until delivery and the pregnancy was under close supervision. However, when she arrived at the hospital, the hospital failed to notify and consult her obstetrician. An emergency C-section was performed, but the complaint contends that the procedure was not performed in time to prevent reduced oxygen flow to the fetal brain, causing brain damage. Click for more information
    • A $5 million suite filed against a military hospital in Kentucky also results from HIE. The suit contends that connected to a fetal heart rate monitor, the healthcare workers failed to properly monitor and interpret the tracings. The plaintiff claims that the medical records indicate her daughter was in respiratory failure for a long period of time. In addition, the complaint states that, despite knowing that the labor was not progressing properly, healthcare providers failed to perform a cesarean section. The newborn was diagnosed with intracerebral hemorrhage and interventricular hemorrhage. Click for details

 

¹Anupam B. Jena, M.D., Ph.D., Seth Seabury, Ph.D., Darius Lakdawalla, Ph.D., and Amitabh Chandra, Ph.D. Malpractice Risk According to Physician Specialty N Engl J Med 2011; 365:629-636

14 Mar

Discuss EFM data vs clinical information

Are you using just data or rich clinical information to assess labor?

Here’s a definition of data

According to Merriam-Webster’s dictionary, data is the output from a sensing device that includes both useful and relevant or redundant information and must be processed to be meaningful.

Typical perinatal EFM software provides labor data

Here’s a familiar example:
Traditional electronic fetal monitoring systems, developed long before computers made real-time analysis possible in a hospital setting, deliver numeric measurements of fetal heart rate and contractions and presents them in graph form.

Converting this obstetric data to information of actual use is left entirely up to clinicians in their role as human calculators.

Here’s a definition of clinical information

Knowledge obtained from investigation, study, or instruction which justifies change in a plan or theory.

Perinatal Clinical Information fuels better childbirth decision-making

Information-rich decision support tools, illustrated in the PeriCALM® screenshot shown above, convert data into intelligence that make more robust interpretation and decision-making possible.

How many perinatal nurses are limited to just using data to assess labor?

Does your EFM software system deliver data or information?

Which is of more use?  How would having the rich clinical information shown above make a difference with your work?

10 Mar

Best practices for High Reliability

best practices for high reliability in obstetricsUsing their extensive experience in implementing approaches to promote efficiency and high reliability in health care, the team of obstetric leaders who collaborated to author the recently released eBook A Vision of the Future of Obstetrics identified five key clinical best practices.  Here they are in summary:

Best practices for obstetric units

  1. Select a reasonable process
  2. Analyze and modify
  3. Target critical behaviors
  4. Clarify and define
  5. Choose wisely

The free eBook details clinical processes, developed by leading health systems, to execute these broad principles.

What practices is your hospital or health system using to improve efficiency and high reliability in labor & delivery?

Click to continue reading eBook in the Apple Store or as a PDF

03 Mar

A look behind to look ahead

Look into the future of obstetricsA look behind to look ahead for PeriGen

by Matthew Sappern
Chief Executive Officer, PeriGen

I know we are well in to 2016 already, but I want to take a moment to reflect on 2015 and the State of PeriGen.

This past year, PeriGen enjoyed explosive growth. Almost twice as many hospitals went live on PeriGen solutions than in any other year in our history! At the same time, we introduced a remarkable new module called the PeriCALM Checklist which helps makes checklist compliance easier; this tool won the 2015 FIERCE Healthcare Innovation Award.

In 2016, we will introduce a few more tools – tools designed to save nurses time as well as to leverage precious clinical resources across an entire healthcare system – more on these exciting innovations in a few months!

Now, we all know that explosive growth is a double-edged sword. PeriGen cannot allow this growth to come at a cost of service and responsiveness. To that end, we have added some new staff and tools to our implementation and support groups. Inside you will read about new FAQ tools and about Securelink, an application providing our team with secure, remote access – at a hospital’s request – to help troubleshoot issues. We are making support simpler, easier and more efficient. As I made clear to the entire PeriGen team on a recent “all-hands” call, we need to commit to providing an exceptional customer experience in 2016, nothing less.

Finally, as we all settle in to 2016, I invite you to spend some time with PeriGen’s SVP of Clinical Research Dr. Emily Hamilton, who has penned an article with some predictions about continued innovation in healthcare. Emily is one of the most forward-thinking professionals in healthcare today, I am sure you will enjoy her article and you will see PeriGen’s solutions continue to reflect her thinking.

As always, thank you for being a member of the PeriGen family and thank you for taking such great care of all the mothers and babies whose lives you touch.  Have a wonderful 2016!

02 Mar

PeriGen Predictions 2016

Rethinking the Labor CurvePeriGen Predictions 2016

by Emily Hamilton, MDCM
Senior Vice President of Clinical Research

We all enjoy lists of predictions for the coming year; hot stocks picks, fashion styles – what’s cool, what’s not, baby names- what’s in, what’s out and the rising or falling stars of society’s influencers, to name a few.

At PeriGen, our thoughts also turn to the future and we have prepared some projections of our own.   But first, history does inform the future. Upon reflection, the common thread throughout PeriGen’s history has been innovation.   However turning ideas into concrete solutions is much more than having a bright idea.

…turning ideas into concrete solutions that work is much more than having a bright idea.

At the most fundamental level our innovations must solve a real need in a fashion that improves the efficiency of clinicians, in a cost beneficial fashion favorable to both institutions and individuals. Furthermore they must do this in a manner that is better, safer, cheaper, faster, and more expedient and sustainable than the solution currently in place. These criteria make innovation a very tall order. Successful innovation teams focus on the problems they understand deeply, but they – when needed — also recognize and source missing resources of expertise to create novel solutions.   Failure to involve real clinicians, assessing the new prototypes in real world situations, early on when product definition is still malleable, is a pitfall that leads to failure.

With those lessons in mind here is our list for 2016 (and a bit beyond). We invite you to comment on it.

An EHR’s ability to meet the requirements for Meaningful Use, e-prescribing, health information exchanges, interoperability, and ICD-10 coding are all major considerations for health care institutions. We expect to see the trend toward EHR convergence continue.

In reverse order, here are the top 3 trends in 2016 and beyond.

PeriGen’s Projection for
Healthcare Technology Trends

#3  More Personalized and Intelligent Data Analysis

With improved interoperability well underway hospitals are searching for solid evidence of both health and financial benefits. We expect to see HIT applications specifically tailored to address underlying causes of error at the bedside, improve diagnosis and treatment, and help managers track performance in their departments.

There are only so many rules that a human mind can hold and process, especially when considering multiple factors that change over time in busy clinical environments. However, with the computational capacity of everyday computers it is possible to apply a number of well-established statistical techniques to reduce subjective and inconsistent human assessment, to assess personalized likelihood of adverse outcome and warn clinicians in time so they can change management and minimize untoward consequences.

Statistical reports analyzing trends in outcomes and processes help unit directors define, prioritize, and monitor quality-of-care benchmark initiatives. Performance measurements are essential to show where progress has occurred or where it is needed. They also help to motivate clinical teams (and individuals) with evidence of their own success or need for improvement.

We expect to see many more applications layered onto the basic EHR for intelligent analysis and data display, making it easier for clinicians to care for patients and for directors to manage their departments.

#2  Increased Use of Cloud-Based Technologies

Increasing prevalence of wearables and devices using mobile and cloud-based technologies bring individualized data to patients and clinicians wherever they are, whenever they want. Pregnant women in general are well-educated, young, and accustomed to technology. This modern reality gives rise to expectations that health records and even meaningful healthcare itself can be provided this way as well.   Not only will these technologies collect and return personalized analysis, the collective data is a gold mine for medical researchers.

#1  Expansion of Virtual Centers of Expertise

The two trends mentioned above facilitate the creations of virtual centers of expertise. Once a novelty, the virtual center of expertise is becoming common place in business and in healthcare.

Evidence of this includes:

In healthcare, virtual ICUs are increasingly common in the US.   A virtual command center staffed with nurses and doctors using high-resolution video conferencing and transmission of monitoring data can be hundreds of miles away and serve multiple remote sites simultaneously. Not only are such centers showing improvement in outcomes, patients are reporting high levels of satisfaction with much easier access to clinical expertise.

In some places the center acts as a second set of eyes, in others it is a source of consultative expertise.

By 2018, the global market for telemedicine devices and services is projected to grow to US$4.5 billion and the U.S. market is expected to grow to $1.9 billion1.

Virtual centers of expertise are feasible only with reliable infrastructure to support rapid data exchange. If gathering, assimilating and sharing information are the foundations upon which decisions are made at the bedside, in virtual centers their importance is multiplied many-fold. Although standardization may be easier to achieve given the relatively small group of experts who staff such a virtual center, they will face other pressures, such as vigilance fatigue when potentially hundreds of virtual patients are under their care at any one time.

Automated intelligent methods to prioritize the true level of abnormality and direct the expert’s attention to the most urgent issues are imperative in such centers. Good prioritization is particularly important in obstetrical situations where false alarms are common and adverse events are rare but can devolve rapidly with dire consequences.

To quote Geoff Mulgan, CEO, National Endowment for Science Technology and the Arts (NESTA) , London, UK : “As the Internet of Things advances, the very notion of a clear dividing line between reality and virtual reality becomes blurred, sometimes in creative ways.”

We project the healthcare will see an increasing numbers of virtual centers of expertise offering an expanded set of services. Our challenge will be to apply technology wisely, measure its performance, and continue to evolve it guided by the search for what is best for patients, efficient for clinicians, and cost effective for society.

“As the internet of things advances, the very notion of a clear dividing line between reality and virtual reality becomes blurred…”

What do you think?  Will these happen?  What else do you expect to change in our world this year?

 

1 Bruce Japsen, “ObamaCare, Doctor Shortage to Spur $2 Billion Telehealth Market,” Forbes, Dec. 22, 2013; “Global Telehealth Market Set to Expand Tenfold by 2018,” IHS, Jan. 17, 2014.

 

25 Feb

Share the Vision | Excerpt

Obstetrics challenge - standardization of care

 

Our OB 3.0 team of thought leaders focused on two key challenges for obstetric patient care.  The first, covered in Section I of the new ebook A Vision of the Future of Obstetrics is standardization of health care.  Here’s an excerpt:

Issues preventing

Standardization of Care

The quest for exciting and game changing approaches to solve today’s medical problems is appealing.  However, not only are such miracles seldom found, but experience shows that much improvement can be gained by applying existing best practices uniformly. 7-9   Across all large endeavors, such uniform processes have been shown to improve outcomes.  The lessons learned from recent and dramatic stories of implementation of various aspects of a comprehensive safety program on the obstetrical unit demonstrate that such uniform processes have, like in other complex organizations, led to widespread improvement in such outcomes as lowering cesarean section rates and decreasing malpractice claims and costs.10-15  In health care, standardization generally reduces costs.

When considering impediments, two issues quickly took the lead: Miscommunication and normalization of deviance.

Are miscommunication and normalization of deviance challenges that your labor & delivery unit face?  What has your team done to combat them?

Continue reading via Apple Store download or as a PDF