Speaking up during the morning "huddle" in Einstein Philadelphia Labor & Delivery
Morning "huddle" at Einstein Philadelphia Labor & Delivery
Checking what
Ob-Gyn

Culture of Communication Key to Safety for Patients Giving Birth

By on 08/12/2020

Operating room technician Katrina Dunlap was worried. Staff members at Einstein Medical Center Philadelphia used a slide board to lift patients from a stretcher to the operating table for a cesarean section. It required a lot of effort, so slip-ups could happen. 

She suggested they start using a device called a HoverMatt, which mostly automates the whole transfer process.  

David Jaspan, DO, Chair of Obstetrics and Gynecology for Einstein Healthcare Network, thought it was a great idea. The hospital bought the device, and it’s now used for all OB patient transfers.

Dunlap felt free to voice her concerns because of the culture in Obstetrics at Einstein Philadelphia, where everyone is laser-focused on the safety of patients and their babies.

‘If There’s a Concern, Raise It’

It begins with training people to ask themselves, constantly, “How can the next patient be harmed? And most importantly, what can I do to prevent it?” Dr. Jaspan says.

“It sounds very simple,” he says, “but it’s empowering and it goes to the people who clean rooms, bring food, provide the care — anybody. And if there’s a concern, raise it. And most importantly, from my leadership perspective, make sure that concern is addressed.”

Those efforts, which intensified several years ago, have paid off exceptionally well. Einstein has the city’s lowest rates – by far – of complications that can happen for people having babies, known as maternal morbidity.

Preventing complications rests on a foundation of excellent medical care – including standard procedures based on the latest evidence – and open communication. Empowering everyone to call attention to potential problems is a vital component, Dr. Jaspan says.

“We have a good culture where we really listen to the patient and really listen to each other,” says Casey Carney, MD, a fourth-year chief resident in obstetrics and gynecology (OBGYN).

Seeking Constant Improvement

Away from the bedside, committees meet regularly to look for ways to do things better. They include obstetricians, pediatricians, nurses, and sometimes other departments such as pharmacy, dietetics and housekeeping.

“It’s that communication and a focus on quality, focus on practice, bringing problems forward that are listened to,” says Jane Lodise, MSN, RNC, Nurse Manager of the Mother-Baby Unit. “When you put all that together, I think it’s made a huge impact.”

Ideas can come from anywhere – a suggestion from a staff member, new research, or new data about Einstein patients. Solutions often involve looking at evidence from medical literature to make sure that best practices are used, every time.

Ideas that have been implemented include:

  • From a nurse: Using drapes under patients that measure blood loss and alert staff if there’s a danger of hemorrhage so they can take steps to prevent it
  • From a nurse-pharmacy brainstorm: Packaging medication and supplies to treat hemorrhage in designated storage spaces, to reduce response time
  • From various staff members: Having routine communications involving nurses, residents and supervising doctors take place at the bedside so patients can listen and speak up
  • From a transport staff member: Buying bigger wheelchairs to accommodate larger patients
  • From a doctor: Having twice-daily, 15-minute “huddles” of doctors and nurses to make sure everyone knows what’s expected for the next shift
  • From data reports: Adopting new standard steps in care that reduced surgery-site infections after cesarean section to almost zero.

“We’ve been just working and looking and asking, ‘How can we do this better?’” says Anneliese Gualtieri, BSN, RNC, Patient Safety and Quality Nurse at Einstein Philadelphia. “It’s all of these constant little tweaks.”

Preventing and Preparing for Problems

Most patients who give birth have no problems with the delivery. But the Einstein staff has focused on preventing or catching early any possible complications.

“One of the things that people still die from in 2020 is hemorrhage after the baby’s born,” Gualtieri notes. “So one of the initiatives that we put into place was finding a more precise way to measure the amount of blood loss.”

A nurse did an experiment and discovered that staff didn’t always estimate blood loss accurately. So the unit started using drapes with an attached measuring system under patients during childbirth. Now staff can see at a glance how much blood is lost. This means they can take quick action if it exceeds typical levels.

Although hemorrhage is rare, nurses and pharmacy staff made other changes to improve their response to any worrisome bleeding.

“We worked with pharmacy to have a special space dedicated in the medication carts and in the refrigerators for the right medications,” Gualtieri says. “Now everybody knows where they are every time.”

Supplies also were packaged together in a box on medication carts. “Everything you need to get through those first 15-20 minutes is right there,” Lodise says. Regular drills ensure that everyone stays sharp and ready to act.

At the Bedside, Including the Patient

One of the most important steps to enhance the culture of open communication is having nurses and doctors talk to each other at the patient’s bedside. These practices have been implemented in the last few years.

For example, during nursing shift changes there’s always a report from the departing nurse to the one who is taking over. In the past, that happened at the nursing station. Now it’s done at the bedside.

Similarly, nurses, residents and the senior doctors who supervise the residents conduct “rounds” every day for patients in the hospital and those who are being discharged. They meet at the bedside to review each patient’s progress and plan for the day.

“The patients can participate in the report, make corrections and ask questions,” says Jeanmari Sharkey, RN, a nurse in the Mother-Baby Unit. “This makes the patients more involved in their own care than they used to be. In-room rounding and report gets everybody on the same page on how to care for each patient. It’s everyone’s time to speak up if there’s a concern.”

“Everyone speaks to each other, and at the end of the day, communications will keep people safe,” says Sara O’Neill, RN, of the Mother-Baby Unit. “It does make a difference. And that’s evident because we’re keeping people safe and we’re keeping them healthy.”

Find out more about Einstein Obstetrics.

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