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Statewide Perinatal Quality Improvement, Teamwork, and Communication Activities in Oklahoma and Texas
Elizabeth K Stierman1, Barbara T O'Brien, Julie Stagg
1Departments of International Health (Drs Stierman and Creanga) and Health Policy and Management (Drs Engineer and Berenholtz), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Oklahoma Perinatal Quality Improvement Collaborative, Oklahoma City, (Mss O'Brien and Ouk); The University of Oklahoma Health Sciences Center, Oklahoma City (Mss O'Brien and Ouk); Community Health Improvement Division, Texas Department of State Health Services, Austin (Ms Stagg); Alliance for Innovation on Maternal Health, American College of Obstetricians and Gynecologists, Washington, District of Columbia (Ms Alon); Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, Maryland (Drs Engineer, Benishek, Latif, and Berenholtz, Ms Liu, and Mr Terhorst); Departments of Anesthesiology and Critical Care Medicine (Drs Engineer, Benishek, Latif, and Berenholtz) and Gynecology and Obstetrics (Dr Creanga), Johns Hopkins School of Medicine, Baltimore, Maryland; and Agency for Healthcare Research and Quality, Rockville, Maryland (Drs Fabiyi and Mistry and Mss Chew and Harding).
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.
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