Improving communication and teamwork during labor: A feasibility, acceptability, and safety study

Abstract

Background: TeamBirth was designed to promote best practices in shared decision making (SDM) among care teams for people giving birth. Although leading health organizations recommend SDM to address gaps in quality of care, these recommendations are not consistently implemented in labor and delivery.

Methods: We conducted a mixed-methods trial of TeamBirth among eligible laboring patients and all clinicians (nurses, midwives, and obstetricians) at four high-volume hospitals during April 2018 to September 2019. We used patient and clinician surveys, abstracted clinical data, and administrative claims to evaluate the feasibility, acceptability, and safety of TeamBirth.

Results: A total of 2,669 patients (approximately 28% of eligible delivery volume) and 375 clinicians (78% response rate) responded to surveys on their experiences with TeamBirth. Among patients surveyed, 89% reported experiencing at least one structured full care team conversation ("huddle") during labor and 77% reported experiencing multiple huddles. There was a significant relationship between the number of reported huddles and patient acceptability (P < 0.001), suggestive of a dose response. Among clinicians surveyed, 90% would recommend TeamBirth for use in other labor and delivery units. There were no significant changes in maternal and newborn safety measures.

Conclusions: Implementing a care process that aims to improve communication and teamwork during labor with high fidelity is feasible. The process is acceptable to patients and clinicians and shows no negative effects on patient safety. Future work should evaluate the effectiveness of TeamBirth in improving care experience and health outcomes.

Keywords: communication; labor and delivery; shared decision making.

FIGURE 1

Patient‐reported Fidelity of TeamBirth Implementation. Data collected through patient surveys in the postpartum period before hospital discharge. The instance of huddles increased in frequency over time with almost 10‐percentage point increases in the frequency of one or multiple huddles (86% to 93% for one; 75% to 82% for multiple)

FIGURE 2

Patient‐Reported Acceptability of TeamBirth. Data collected through patient surveys in the postpartum period before hospital discharge. Over eight months of our implementation, 99% of all patients surveyed definitely or somewhat had the role they wanted in making decisions about their labor. Among the subset of patients who wanted information about what was happening in their labor and delivery process and wanted to make collaborative decisions with their clinicians, 99% definitely or somewhat had the role they wanted in making decisions about their labor. Ninety‐nine percent reported that their nurse and provider definitely or somewhat talked about their labor in a way they could understand and 96% definitely or probably felt that their preferences made a difference in the care they received

FIGURE 3

Patient‐Reported Acceptability of TeamBirth by Number of Huddles Experienced. Data collected through patient surveys in the postpartum period before hospital discharge. Our study shows a significant relationship between the number of huddles patients reported throughout their labor and patient‐reported acceptability, which appears to be suggestive of a potential dose response between huddles and positive experience (P < 0.001)

FIGURE 4

Clinician‐Reported Acceptability of TeamBirth. Among clinicians surveyed after eight months of implementation, 90% of nurses, midwives, and obstetricians reported they would definitely (68%) or probably (22%) recommend TeamBirth for use in other labor and delivery units (A). Ninety‐four percent reported that the project definitely (60%) or somewhat (34%) improves care for patients, and 88% reported that the project definitely (42%) or somewhat (46%) helps clarify when a cesarean birth should be performed in nonurgent situations (B)