Achieving Strong Teamwork Practices in Hospital Labor and Delivery Units (Technical Report)

  1. Confronting Safety Gaps across Labor and Delivery Teams
  2. Introduction
  3. Teamwork and Clinical Error Reporting among Nurses in Korean Hospitals - ScienceDirect

Site selection was also influenced by the availability of a local obstetrical practitioner champion to lead the project. Other components of the program included improved documentation of the team management steps for shoulder dystocia events, mitigating patient harm, and using clinical lessons to improve practice.

The initial and biennial each took approximately 1. The PET included an obstetrical practitioner principal investigator PI , the obstetrics nurse lead, a risk manager, a project manager, and a medical coder.

Confronting Safety Gaps across Labor and Delivery Teams

Each local PET educated the full obstetrics staff, supervised the program, and maintained ongoing communication with other study sites. The project managers served as the lead contact at each site, coordinated maternal and infant study enrollments, disseminated materials, and organized meetings.

Achieving Strong Teamwork Practices in Hospital Labor and Delivery Units Technical Report

The project manager also collected clinician education and training data and ensured the accuracy of clinical documentation and coding by performing chart reviews of patients enrolled in the study. Site trainers also conducted simulation training using a Noelle mannequin.


Team training was tailored to each site, while maintaining consistency of care and standardization of documentation. Participation was voluntary, but highly encouraged, for all labor and delivery nurses, physicians, and midwives.

Each study site documented the number of clinicians who participated in the education and training and reviewed these metrics during a monthly conference call. Sites also shared challenges and successful strategies on the call. The shoulder dystocia protocol was implemented from July through June Review of the event reporting system, required delivery note, and medical record revealed that in the first year of the study, there was a threefold increase in shoulder dystocia reporting, representing 99 percent compliance in shoulder dystocia reporting by delivery providers.

In addition, the review revealed that there were no undocumented shoulder dystocia events at any of the five testing sites in the year following implementation.

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In years 2 and 3, the testing sites sustained the 99 percent compliance rate. Sites observed some variation in clinician participation. For instance, one site had one independent obstetrical practitioner of four total delivery providers who did not participate in the shoulder dystocia training the first year it was offered, but it did participate in the second year.

Standardizing clinical practice surrounding shoulder dystocia at Ascension Health required developing an adaptive response at two levels: Every shoulder dystocia event is unique and requires an adaptive response by the clinical care team; there is no standard response that can be prescribed and required of practitioners. However, several factors related to shoulder dystocia can be standardized, such as agreeing upon a shared definition of shoulder dystocia; calling out shoulder dystocia to create situational awareness when it occurs; calling out time intervals to keep the clinical team informed; improved documentation of shoulder dystocia events; and postevent debriefing to identify improvement opportunities.

The shoulder dystocia response and management protocol provided structure, clinical practice parameters, and required clinical guideline adoption, but it did not dictate specific clinical response. Similarly, the implementation and management plan was adaptive. To individualize the program at diverse sites, specific training and education elements were required of clinicians, but local project managers structured program introduction methods, scheduling, and staff feedback.

Site leaders understand local culture and local personnel and are more likely to identify impeding and promoting factors. We found that including obstetrical leaders and clinicians in crafting the implementation plan contributed expertise regarding local cultural requirements and also created shared ownership between personnel throughout the system.

Identifying dedicated clinical leaders at each site was an important aspect of creating local accountability and ownership. We found that our local obstetrical practitioner leaders were effective at influencing peers within their own hospitals as well as assisting teams at other hospitals to adopt the shoulder dystocia response and management protocol, especially as their collective input was utilized to inform practice changes. We also found that practitioner status as either employed by the hospital or in an independent practice did not influence their voluntary participation in the training and new documentation requirements.

By gathering and analyzing clinician training records, medical records, and adverse perinatal events, it was possible to spot gaps in training and to use adverse events and near misses as opportunities to discover practice or systemic issues that required attention.

Teamwork and Clinical Error Reporting among Nurses in Korean Hospitals - ScienceDirect

As a case study, there are limitations in our findings. The implementation was tested in only five study sites and a lot could be learned from the spread of this initiative to additional sites. As practitioner participation was voluntary, it was important that frontline clinicians partnered in the development of the shoulder dystocia protocol, and opinion leaders advocated for the program during implementation.

Feedback following training was solicited from practitioners and documented, in order to further adjust the program where necessary. During the implementation, a simulation training component allowed clinicians to hone teamwork and shoulder dystocia response and management protocol methods during a simulated obstetrical emergency. National Center for Biotechnology Information , U. Journal List Health Serv Res v. Published online Oct Susan Ridgely, Michael D. Greenberg, and Carolyn M. Zalenski 2 Department of Obstetrics and Gynecology, St.

Edwards 3 Department of Obstetrics and Gynecology, St. Vincent's Birmingham, Birmingham, AL. This article has been cited by other articles in PMC. Abstract Objective To establish multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. Study Design Case study evaluation methodology was used to examine clinician engagement and protocol adoption. Data Collection Methods The training completion for all practice engagement team activities was collected by the site project manager and entered into a flat file.

Principal Findings In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. Conclusions System and site management teams implemented a standardized shoulder dystocia protocol that fostered effective teamwork and obstetric team readiness for managing shoulder dystocia emergencies. Shoulder dystocia, guidelines, adherence. Materials and Methods Ascension Health is the largest nonprofit health system in the United States and the world's largest Catholic health system, providing care to almost , hospitalized patients per year.

Study Sites and Interventions Five study sites within Ascension Health were selected for implementation of the shoulder dystocia response and management protocol. We measured teamwork using the Teamwork Perceptions Questionnaire, which has five subscales including team structure, leadership, situation monitoring, mutual support, and communication. Using logistic regression analysis, we determined the relationships between teamwork and error reporting. The response rate was The mean score of teamwork was 3.

At the subscale level, mutual support was rated highest, while leadership was rated lowest. Of the participating nurses, responded that they had experienced at least one clinical error in the last 6 months. Among those, only Teamwork was significantly associated with better error reporting. Teamwork was rated as moderate and was positively associated with nurses' error reporting performance. Hospital executives and nurse managers should make substantial efforts to enhance teamwork, which will contribute to encouraging the reporting of errors and improving patient safety.

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