Obstetric Practice Survey: Factors perceived to promote successful management of challenging or risky obstetric patient situations
Abstract Number: F-12
Abstract Type: Original Research
Introduction: Collaboration & teamwork are especially important in achieving timely & safe care in emergent, high-risk situations.(1) Before considering interventions to improve teamwork & communication on an increasingly busy inter-professional (IP) obstetric unit, we first identified factors currently perceived by providers as contributing to successful management of demanding cases.
Methods: All providers in 4 major disciplines (obstetrics, anesthesiology, nursing, midwifery) participating in inpatient obstetric care were contacted by e-mail, and asked to complete an anonymous survey (14 open-ended questions, 40 agreement statements, demographic data) evaluating perceptions of teamwork & safety. Data were analyzed after the 4-week survey period concluded. All 3 investigators coded answers independently, negotiated differences, and identified dominant themes. Analysis was facilitated by qualitative data software (NVivo9, QRS Internat’l Pty Ltd). This analysis is limited to one question: “What factors seem to have contributed to successful management of challenging, risky, or dangerous obstetric situations?”
Results: Response rate: 122/254 (52%), incl. 21 partially completed surveys. Dominant themes included communication, collaboration/teamwork, proactive preparation & planning for high-risk parturients, physicians & senior nurse support, leadership, education (incl. simulation & drills), technology & safety features, equipment & supplies organized specifically for emergencies. Communication subthemes included inclusiveness of team members, cell phone OB emergency team (OBET) summons/response system (recently implemented to facilitate rapid recruitment of all team members to critical situations), timeliness, direct communication (incl. cell phones), clear & calm manner, “often”/”frequent”. Representative excerpts are presented (table).
Conclusions: Respondents overwhelmingly identified communication as vital in managing critical situation successfully. Many identified factors are consistent with aspects thought to contribute to quality & safety in dynamic domains of healthcare.(1,2) Prior to formal intervention or education, there is already a great deal of front-line awareness & knowledge among respondents, which will help to inform improvement planning, as well as will serve as a baseline for post-intervention comparison.
Ref: 1) Manser T. Acta Anaesthesiol Scand 2009;53:143-51; 2) Guise JM, Segel S. Best Pract Res Clin Obstet Gynaecol 2008;22:937-51