Main Elliott K, Dhurjati Ravi, Cape Valerie, Vasher Julie, Abreo Anisha, Chang Shen-Chih, Gould Jeffrey B
Jt Comm J Qual Patient Saf. 2018 May;44(5):250-259. doi: 10.1016/j.jcjq.2017.11.005.
Obstetric safety bundles, consisting of action steps shown to improve outcomes, have been developed to address the most common and preventable causes of maternal morbidity and mortality. Implementing these best practices across all birthing facilities remains an important and challenging clinical and public health priority.
The California Maternal Quality Care Collaborative (CMQCC) developed an innovative external mentor model for large-scale collaborative improvement in which participating organizations were subdivided into small teams of six to eight hospitals, led by a paired dyad of physician and nurse leaders. The mentor model preserves the active sharing that enhances improvement across a large group of facilities working on the same project while enabling individualized attention to teams. The mentor model was tested by implementing the obstetric hemorrhage safety bundle (which consists of 17 key practices in four domains) in multiple California hospitals.
A total of 126 hospitals were engaged to simultaneously implement the safety bundle. The adoption rates for the recommended practices in the four action domains were (1) Readiness, 78.9%; (2) Recognition and Prevention, 76.5%; (3) Response, 63.1%; and (4) Reporting and Systems Learning, 58.7%. Mentors (31/40) and participating teams (48 responses from 39/126 hospitals) provided feedback in an exit survey. Among the respondents, 64.5% of mentors and 72.9% of participants agreed that compared to a traditional collaborative structure, the mentor model was better suited for quality improvement at scale.
The mentor model was successful in providing individualized support to teams and enabled implementation of the hemorrhage safety bundle across a diverse group of 126 hospitals.
产科安全包由一系列经证实可改善结局的行动步骤组成，旨在解决孕产妇发病和死亡的最常见且可预防的原因。在所有分娩机构中实施这些最佳实践仍然是一项重要且具有挑战性的临床和公共卫生优先事项。
加利福尼亚孕产妇质量护理协作组织（CMQCC）开发了一种创新的外部指导模式，用于大规模协作改进，参与组织被细分为由医生和护士领导组成的六至八家医院的小团队。指导模式保留了积极的分享，这增强了在从事同一项目的一大群机构中的改进，同时能够对团队进行个性化关注。通过在加利福尼亚多家医院实施产科出血安全包（由四个领域的17项关键实践组成）来测试指导模式。
共有126家医院参与同时实施安全包。四个行动领域中推荐实践的采用率分别为：（1）准备，78.9%；（2）识别与预防，76.5%；（3）应对，63.1%；（4）报告与系统学习，58.7%。指导者（31/40）和参与团队（来自39/126家医院的48份回复）在退出调查中提供了反馈。在受访者中，64.5%的指导者和72.9%的参与者同意，与传统协作结构相比，指导模式更适合大规模的质量改进。
指导模式成功地为团队提供了个性化支持，并使出血安全包能够在126家不同的医院中得以实施。
