Optimizing Safety of Mother and Neonate in a Mixed Methods Learning Laboratory

Principal Investigator: Louis Halamek, M.D., Stanford University, Stanford, CA
AHRQ Grant No.: HS023506
Project Period: 09/30/14–09/29/19

Description: The goal of this project was to establish a PSLL to advance patient safety for neonates and mothers before, during, and after delivery. The laboratory carried out four interrelated projects to:

1. Develop and test an optimal neonatal resuscitation data display.
2. Develop and test an optimal maternal data display.
3. Develop a process to recognize and prevent maternal clinical deterioration, and
4. Develop the optimal physical design of a labor and delivery suite.

The specific aims were to:

1. Study how flow of communication may affect patient safety. In this context, the flow of communication usually referred to the passing of information (in either direction) between clinicians and others, primarily other clinicians.
2. Examine how physical design elements may affect patient safety. These elements ranged from design of physical devices and organization of patient beds and storage spaces to layout of a patient room.
3. Develop a systematic method to study patient safety using a stepwise approach of problem analysis through qualitative research, design, development, implementation, and evaluation.

This PSLL for Neonatal and Maternal Care comprised multidisciplinary teams of obstetricians, neonatologists, nurses, design specialists, engineers, and parent representatives. The lab developed, piloted, and tested innovative designs that resulted in the creation of:

• A maternal data display for the obstetrical team designed to improve situation awareness and enhance care during crises. Maternal decompensation during and after labor can be unanticipated and rapid, and it may go unrecognized until it is too late. The display—linked to the electronic medical record (EMR)—provides easily recognizable visual cues (e.g., color-coding) to avoid this problem. A provisional patent for the display is in preparation.^1-4
• A neonatal data display designed to show key neonatal physiologic variables (such as heart rate and minute-to-minute changes in hemoglobin-oxygen saturation) in a manner that supports decision making.^1-4
• A delayed cord-clamping cart (DCCC) designed to provide a stable platform for the neonate while still connected to the umbilical cord. Evidence indicates short- and long-term benefits of delaying umbilical cord clamping for 30 to 60 seconds in preterm and term neonates. The DCCC offers a solution to the ergonomic issues (e.g., small physical space) inherent during delivery while maintaining sterility.^1,4,5 A patent was filed for the DCCC in 2018.
• A labor and delivery room designed to provide comfort and privacy for women in labor while meeting the needs of healthcare professionals caring for these women and their newborns, even during a crisis. This design facilitates safe, effective, and efficient patient care.^1,2,6,7
• A pelvic lift cushion designed to provide a comfortable, effective, reusable, inexpensive, and portable option for women when gynecological beds (with stirrups) are not available.^1,4,5

Knowledge gained from this PSLL has been disseminated via at least 10 peer-reviewed publications, presentations at multiple conferences, and several posters.

References

1. AFYA. Internal Communication. Patient Safety Learning Laboaratories In-Person Meeting Report: Design, Evaluate, Transform. AHRQ, Rockville, MD, 2019.
2. AFYA. Internal Communication. Patient Safety Learning Laboaratories In-Person Meeting Report. AHRQ, Rockville, MD, 2017.
3. AFYA. Internal Communication. PSLL CONNECT Newsletter: Issue 1. AHRQ, Rockville, MD, 2018.
4. AFYA. Internal Communication. PSLL CONNECT Newsletter: Issue 3, AHRQ, Rockville, MD, 2018.
5. AFYA. Internal Communication. PSLL CONNECT Newsletter: Issue 5. AHRQ, Rockville, MD, 2019.
6. Sherman JP, et al. Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth. Am J Perinatol 2020 May;37(6):638-46. Accessed June 12, 2020.
7. AFYA. Internal Communication. PSLL CONNECT Newsletter: Issue 2. AHRQ, Rockville, MD, 2018.

Grant Publications

All links below were accessed June 12, 2020.

2019

• Halamek LP, et al. Using briefing, simulation and debriefing to improve human and system performance. Semin Perinatol 2019;43(8):151178.
• Lapcharoensap W, et al. Safety and ergonomic challenges of ventilating a premature infant during delayed cord clamping. Children (Basel) 2019 Apr;6(4):59.
• Sherman JP, et al. Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth. Am J Perinatol 2020 May;37(6):638-46.
• Yamada NK, et al. Ergonomic challenges inherent in neonatal resuscitation. Children (Basel) 2019 Jun;6(6):74.

2018

• Austin N, et al. Analyzing the heterogeneity of labor and delivery units: A quantitative analysis of space and design. PLoS One 2018;13(12):e0209339.
• Lyndon A, et al. Thematic analysis of women's perspectives on the meaning of safety during hospital-based birth. J Obstet Gynecol Neonatal Nurs, 2018 May;47(3):324-32.
• Sherman J, et al.Medical device design education: identifying problems through observation and hands-on training. Des Technol Educ 2018;23(2):154-74.
• Tan M, et al. Evaluation of electronic medical records on nurses' time allocation during cesarean delivery. J Patient Saf, 2019 Dec;15(4):e82-e85.

2017

• Daniels K, et al. Opportunities to foster efficient communication in labor and delivery using simulation. AJP Rep 2017 Jan;7(1):e44-e48.
• Lapcharoensap W, Lee HC. Tackling quality improvement in the delivery room. Clin Perinatol, 2017;44(3):663-81.