Development of a Quality Indicator to Measure Urgent Requests to the Bedside

Abstract

Objective: To develop a quality indicator describing the response time to an urgent request for a physician to the bedside of a pregnant or postpartum woman and to identify opportunities for improvement in care timeliness for women with worsening serious clinical conditions.

Design: Evidence-based quality improvement project using the Iowa Model-Revised framework to develop a maternal care quality indicator.

Setting: Labor and delivery, antepartum, and mother/baby units in a large urban safety-net hospital preparing for a state level of maternal care designation survey.

Participants: All nurses and physicians caring for hospitalized pregnant and postpartum women participated in implementation.

Intervention/measurements: Physician response time was measured as the elapsed time from a nurse's urgent request for a physician and the presence of a physician at the bedside of a woman in one of the identified units, as recorded in the electronic health record.

Results: Physician response time to an urgent request to the bedside was documented 179 times during the first 3 months after implementation. Physician presence at the bedside within 30 minutes of a request was recorded in more than 99% of these events.

Conclusion: Physicians' responses to early warning signs within our facility were timely and within the parameters established by the Texas state-mandated criteria for a Level IV maternal care hospital. Response time as documented in the electronic health record provides an important quality indicator of maternal care in the inpatient setting.

Keywords: early warning; electronic health record; evidence-based practice; maternal; obstetric; peripartum; pregnancy; quality improvement.