Introduction of an obstetric-specific medical emergency team for obstetric crises: implementation and experience
ABSTRACT We describe the implementation and experience with adding an obstetric-specific medical emergency team (called Condition O for obstetric crisis) to an existing rapid response system at Magee-Womens Hospital.
In response to deficits identified during patient safety review of adverse obstetric events in 2004 and 2005, the hospital administration decided to add a crisis team with expertise specifically designed for maternal and/or fetal crises.
During the first 6 months, staff rarely called Condition O (14 per 10,000 obstetric admissions). After reeducation efforts, use of Condition O increased to 62 per 10,000 obstetric admissions during 2006.
We outline our hospital's experience with implementation, efforts to address low utilization, and 1.5 years of Condition O event data. Condition O is a work in progress. In light of this, we discuss the challenges of measuring its patient safety outcome, considerations for team size and composition, and our efforts to determine an optimal Condition O rate.
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Chapter: Uterine Atony: Management StrategiesBlood Transfusion in Clinical Practice, 03/2012; , ISBN: 978-953-51-0343-1
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ABSTRACT: Practitioners of patient safety practice change agree that champions are central to the success of implementation. The clinical champion role is a concept that has been widely promoted yet empirically underdeveloped in health services literature. Questions remain as to who these champions are, what roles they play in patient safety practice change and what contexts serve to facilitate their efforts. This investigation used a multiple-case study design to critically examine the role of champions in the implementation of rapid response teams (RRTs), an innovative complex patient safety intervention, in two large urban acute care facilities. An analysis of interviews with key individuals involved in the RRT implementation process revealed a typology of the patient safety practice champion that extended beyond clinical personnel to include managerial and executive staff. Champions engaged to a varying extent in a number of core activities, including education, advocacy, relationship building and boundary spanning. Individuals became champions both through informal emergence and a combination of formal appointment and informal emergence. By identifying and elaborating upon specific features of the champion role, this study aims to expand the dialogue about champions for patient safety practice change.Healthcare quarterly (Toronto, Ont.) 08/2009; 12 Spec No Patient:123-8. DOI:10.12927/hcq.2009.20979
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ABSTRACT: Each year 1.02 million intrapartum stillbirths and 904,000 intrapartum-related neonatal deaths (formerly called "birth asphyxia") occur, closely linked to 536,000 maternal deaths, an estimated 42% of which are intrapartum-related. To summarize the results of a systematic evidence review, and synthesize actions required to strengthen healthcare delivery systems and home care to reduce intrapartum-related deaths. For this series, systematic searches were undertaken, data synthesized, and meta-analyses carried out for various aspects of intrapartum care, including: obstetric care, neonatal resuscitation, strategies to link communities with facility-based care, care within communities for 60 million non-facility births, and perinatal audit. We used the Lives Saved Tool (LiST) to estimate neonatal deaths prevented with relevant interventions under 2 scenarios: (1) to address missed opportunities for facility and home births; and (2) assuming full coverage of comprehensive emergency obstetric care and emergency newborn care. Countries were first grouped into 5 Categories according to level of neonatal mortality rate and examined, and then priorities were suggested to reduce intrapartum-related deaths for each Category based on health performance and possible lives saved. There is moderate GRADE evidence of effectiveness for the reduction of intrapartum-related mortality through facility-based neonatal resuscitation, perinatal audit, integrated community health worker packages, and community mobilization. The quality of evidence for obstetric care is low, requiring further evaluation for effect on perinatal outcomes, but is expected to be high impact. Over three-quarters of intrapartum-related deaths occur in settings with weak health systems marked by low coverage of skilled birth attendance (<50%), low density of skilled human resources (<0.9 per 1000 population) and low per capita spending on health (<US $20 per year). By providing comprehensive emergency obstetric care and emergency newborn care for births already occurring in facilities, 327,200 intrapartum-related neonatal deaths could be averted globally, and with full (90%) coverage, 613,000 intrapartum-related neonatal deaths could be saved, primarily in high mortality settings. Even in high-performance settings, there is scope to improve intrapartum care and especially reduce impairment and disability. Addressing missed opportunities for births already occurring in facilities could avert 36% of intrapartum-related deaths. Improved quality of care through drills and audit are promising strategies. However, the majority of deaths occur in poorly performing health systems requiring urgent strategic planning and investment to scale up effective care at birth, neonatal resuscitation, and community mobilization as well as to develop, adapt, and introduce tools, technologies, and task shifting to reach the poorest.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 08/2009; 107 Suppl 1:S123-40, S140-2. DOI:10.1016/j.ijgo.2009.07.021 · 1.56 Impact Factor