Care bundles, communication, teamwork get results

Leveraging knowledge gained from previous initiatives, including an Institute for Healthcare Improvement (IHI)/Ascension Health/Premier collaboration, hospitals in the Premier Perinatal Safety Initiative (PPSI) use two methods to create high-reliability healthcare teams: increased adherence to evidence-based care bundles, and enhanced communication and teamwork.

Research shows that grouping essential processes in care bundles helps clinical staff remember to take all of the necessary steps to provide optimal care to every patient, every time, says Susan DeVore, Premier president and CEO. Although many hospitals have long followed some or all of these individual care practices to improve perinatal outcomes, the key is consistently using all of them in concert.

Care bundle adherence is scored in an “all-or-none” fashion. The care team must provide all elements of care in the bundle to be given credit for its use. For example, one care bundle is focused on reducing the risks associated with augmenting labor, particularly in using oxytocin, a drug that accelerates a slow labor. This bundle has four elements that must be practiced consistently. If a team neglects to estimate the fetal weight before administering the medication, it would not receive credit for the work, even if team members successfully implemented the three other elements of the bundle.

PPSI hospitals have implemented the following strategies for certain high-risk protocols:

  • TeamSTEPPS: Developed by the Department of Defense and the Agency for Healthcare Research and Quality (AHRQ), TeamSTEPPS produces highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes.
  • Situation Background Assessment Recommendation (SBAR): An effective situational briefing strategy, used by the U.S. Navy, to communicate relevant case facts in a respectful, focused, and effective manner.
  • Simulation drills: Exercises featuring actresses and mannequins reacting as real patients during the birthing process.

Rebecca Price, senior claims manager with Premier Insurance Management Services in Charlotte, NC, notes that in addition to resulting in fewer claims, the PPSI project provides a better defense for the claims that are filed.

“It might make some of those claims easier to defend, and when you make it easier to defend, trial attorneys are not as likely to take it to trial,” Price says. “These tend to be very expensive claims to defend, and if you can truncate the timeline on those claims that are inevitably going to be filed, plus discouraging the filing of a large number of claims, you have tremendously improved the organization’s financial health.”