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Impact of the agency for healthcare research and quality's safety program for perinatal care
Kahwati, L. C., Sorensen, A. V., Teixeira-Poit, S., Jacobs, S., Sommerness, S. A., Miller, K. K., Pleasants, E., Clare, H. M., Hirt, C. L., Davis, S. E., Ivester, T., Caldwell, D., Muri, J. H., & Mistry, K. B. (2019). Impact of the agency for healthcare research and quality's safety program for perinatal care. Joint Commission Journal on Quality and Patient Safety, 45(4), 231-240. https://doi.org/10.1016/j.jcjq.2018.11.002
BACKGROUND: The Safety Program for Perinatal Care (SPPC) seeks to improve safety on labor and delivery (L&D) units through three mutually reinforcing components: (1) fostering a culture of teamwork and communication, (2) applying safety science principles to care processes; and (3) in situ simulation. The objective of this study was to describe the SPPC implementation experience and evaluate the short-term impact on unit patient safety culture, processes, and adverse events.
METHODS: We supported SPPC implementation by L&D units with a program toolkit, trainings, and technical assistance. We evaluated the program using a pre-post, mixed-methods design. Implementing units reported uptake of program components, submitted hospital discharge data on maternal and neonatal adverse events, and participated in semi-structured interviews. We measured changes in safety and quality using the Modified Adverse Outcome Index (MAOI) and other perinatal care indicators.
RESULTS: Forty-three L&D units submitted data representing 97,740 deliveries over 10 months of follow-up. Twenty-six units implemented all three program components. L&D staff reported improvements in teamwork, communication, and unit safety culture that facilitated applying safety science principles to clinical care. The MAOI decreased from 5.03% to 4.65% (absolute change -0.38% [95% CI, -0.88% to 0.12%]). Statistically significant decreases in indicators for obstetric trauma without instruments and primary cesarean delivery were observed. A statistically significant increase in neonatal birth trauma was observed, but the overall rate of unexpected newborn complications was unchanged.
CONCLUSIONS: The SPPC had a favorable impact on unit patient safety culture and processes, but short-term impact on maternal and neonatal adverse events was mixed.
