Statewide Perinatal Quality Improvement, Teamwork, and Communication Activities in Oklahoma and Texas

Abstract

Background and objective: The purpose of this study was to describe statewide perinatal quality improvement (QI) activities, specifically implementation of Alliance for Innovation on Maternal Health (AIM) patient safety bundles and use of teamwork and communication tools in obstetric units in Oklahoma and Texas.

Methods: In January-February 2020, we conducted a survey of AIM-enrolled hospitals in Oklahoma (n = 35) and Texas (n = 120) to gather data on obstetric unit organization and QI processes. Data were linked to hospital characteristics information from the 2019 American Hospital Association survey and hospitals' maternity levels of care from state agencies. We generated descriptive statistics for each state and created an index to summarize adoption of QI processes. We fitted linear regression models to examine how this index varied by hospital characteristics and self-reported ratings for patient safety and AIM bundle implementation.

Results: Most obstetric units had standardized clinical processes for obstetric hemorrhage (94% Oklahoma; 97% Texas), massive transfusion (94% Oklahoma; 97% Texas), and severe hypertension in pregnancy (97% Oklahoma; 80% Texas); regularly conducted simulation drills for obstetric emergencies (89% Oklahoma; 92% Texas); had multidisciplinary QI committees (61% Oklahoma; 83% Texas); and conducted debriefs after major obstetric complications (45% Oklahoma; 86% Texas). Few obstetric units offered recent staff training on teamwork and communication to their staff (6% Oklahoma; 22% Texas); those who did were more likely to employ specific strategies to facilitate communication, escalate concerns, and manage staff conflicts. Overall, adoption of QI processes was significantly higher in hospitals in urban than rural areas, teaching than nonteaching, offering higher levels of maternity care, with more staff per shift, and greater delivery volume (all P < .05). The QI adoption index scores were strongly associated with respondents' ratings for patient safety and implementation of maternal safety bundles (both P < .001).

Conclusions: Adoption of QI processes varies across obstetric units in Oklahoma and Texas, with implications for implementing future perinatal QI initiatives. Notably, findings highlight the need to reinforce support for rural obstetric units, which often face greater barriers to implementing patient safety and QI processes than urban units.

Figure 1.. Self-reported Grade on Patient Safety and Implementation of AIM Patient Safety Bundles by State

In Texas, five hospitals were missing responses on the patient safety grade and six hospitals were missing responses on the AIM implementation grade.

Figure 2.. Use of TeamSTEPPS Tools and Strategies by State and Past Year TeamSTEPPS Training Status

SBAR is a framework used to effectively communicate information about a patient’s condition to members of a healthcare team; the mnemonic stands for S=Situation; B=Background; A=Assessment; and R=Recommendation. DESCR script is a constructive approach for delivering feedback and managing conflict; the mnemonic stands for D=Describe the specific situation; E=Express your concerns; S=Suggest alternatives; C=state Consequences; and R=Reach consensus. One Texas hospital was missing response on use of TeamSTEPPS tools. Twenty-five hospitals (3 in Oklahoma and 22 in Texas) were missing responses on past year TeamSTEPPS training.