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Institution-Specific Perinatal Emergency Checklists: Multicenter Report on Development, Implementation, and
Johanna Quist-Nelson1, Alexander Hannenberg2, Kathryn Ruymann3
1Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
Insights
Developing and implementing perinatal emergency checklists improves obstetric crisis management by reducing redundancy and coordinating care. Simulation and culture change are essential for effective, sustained use of these vital patient safety tools.
Area of Science:
- Obstetrics and Gynecology
- Healthcare Quality Improvement
- Patient Safety
Background:
- Professional organizations recommend checklists to enhance obstetric care.
- Limited research exists on developing, implementing, and sustaining perinatal emergency checklists in clinical settings.
- This study addresses the need for evidence on creating and integrating these tools within diverse hospitals.
Purpose of the Study:
- To investigate the development and implementation processes of perinatal emergency checklists.
- To understand how these checklists are tailored and integrated into different hospital environments.
- To identify facilitators and barriers to the sustained use of perinatal emergency checklists.
Main Methods:
- A qualitative study involving clinicians from three diverse U.S. healthcare systems.
- Institution-tailored perinatal emergency checklists were developed and implemented.
- Interviews were conducted, and transcriptions were analyzed using the Consolidated Framework for Implementation Research.
Main Results:
- Checklists for 19 perinatal emergencies were created, with 10 topics common across all sites.
- Clinicians reported improved patient care during crises, reduced redundancy, and better coordination of obstetric emergencies.
- Checklist development occurred in small groups; implementation was facilitated by developers, with simulation deemed essential for refinement and team use.
Conclusions:
- Processes for developing, implementing, and sustaining perinatal emergency checklists were outlined.
- Multiple, parallel implementation strategies were key to creating a culture shift for checklist integration.
- The findings and framework can guide other institutions in adapting and sustaining perinatal emergency checklists.
Objective:
The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine endorse checklist use to improve obstetric care. However, there is limited research into development, implementation, and sustained use of perinatal emergency checklists to inform individual institutions. This study aimed to investigate the development and implementation of perinatal emergency checklists in diverse hospital settings in the United States.
Study Design:
A qualitative study was conducted individually with clinicians from three health care systems. The participants developed and implemented institution-tailored perinatal emergency checklists. Interview transcriptions were coded using the Consolidated Framework for Implementation Research.
Results:
The study sites included two health care systems and one individual hospital. Delivery volumes ranged from 3,500 to 48,000 deliveries a year. Interviews were conducted with all 10 participants approached. Checklists for 19 perinatal emergencies were developed at the three health care systems. Ten of the checklist topics were the same at all three institutions. Participants described the checklists as improving patient care during crises. The tools were viewed as opportunities to promote a shared mental model across clinical roles, to reduce redundancy and coordinate obstetric crisis management. Checklist were developed in small groups. Implementation was facilitated by those who developed the checklists. Participants agreed that simulation was essential for checklist refinement and effective use by response teams. Barriers to implementation included limited clinician availability. There was also an opportunity to strengthen integration of checklists workflow early in perinatal emergencies. Participants articulated that culture change took time, active practice, persistence, reinforcement, and process measurement.
Conclusion:
This study outlines processes to develop, implement, and sustain perinatal emergency checklists at three institutions. Participants agreed that multiple, parallel implementation tactics created the culture shift for integration. The overview and specific Consolidated Framework for Implementation Research components may be used to inform adaptation and sustainability for others considering implementing perinatal emergency checklists.
Key Points:
· Perinatal emergency checklists reduce redundancy and coordinate obstetric crisis management.. · Perinatal emergency simulation is essential for checklist refinement and effective team use.. · Integrations of perinatal emergency checklists requires culture change and process measurement..
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