Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
Ariadne Labs, Brigham and Women's Hospital, Boston, Massachusetts.
Am J Perinatol. 2024 May;41(S 01):e1099-e1106. doi: 10.1055/a-1990-2499. Epub 2022 Nov 30.
The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine endorse checklist use to improve obstetric care. However, there is limited research into development, implementation, and sustained use of perinatal emergency checklists to inform individual institutions. This study aimed to investigate the development and implementation of perinatal emergency checklists in diverse hospital settings in the United States.
A qualitative study was conducted individually with clinicians from three health care systems. The participants developed and implemented institution-tailored perinatal emergency checklists. Interview transcriptions were coded using the Consolidated Framework for Implementation Research.
The study sites included two health care systems and one individual hospital. Delivery volumes ranged from 3,500 to 48,000 deliveries a year. Interviews were conducted with all 10 participants approached. Checklists for 19 perinatal emergencies were developed at the three health care systems. Ten of the checklist topics were the same at all three institutions. Participants described the checklists as improving patient care during crises. The tools were viewed as opportunities to promote a shared mental model across clinical roles, to reduce redundancy and coordinate obstetric crisis management. Checklist were developed in small groups. Implementation was facilitated by those who developed the checklists. Participants agreed that simulation was essential for checklist refinement and effective use by response teams. Barriers to implementation included limited clinician availability. There was also an opportunity to strengthen integration of checklists workflow early in perinatal emergencies. Participants articulated that culture change took time, active practice, persistence, reinforcement, and process measurement.
This study outlines processes to develop, implement, and sustain perinatal emergency checklists at three institutions. Participants agreed that multiple, parallel implementation tactics created the culture shift for integration. The overview and specific Consolidated Framework for Implementation Research components may be used to inform adaptation and sustainability for others considering implementing perinatal emergency checklists.
· Perinatal emergency checklists reduce redundancy and coordinate obstetric crisis management.. · Perinatal emergency simulation is essential for checklist refinement and effective team use.. · Integrations of perinatal emergency checklists requires culture change and process measurement..
美国妇产科医师学会和母胎医学学会支持使用清单来改善产科护理。然而，关于制定、实施和持续使用围产期急救清单以告知各个机构的研究有限。本研究旨在调查美国不同医院环境中围产期急救清单的制定和实施情况。
对来自三个医疗系统的临床医生进行了单独的定性研究。参与者制定并实施了适合机构的围产期急救清单。使用实施研究综合框架对访谈记录进行编码。
研究地点包括两个医疗系统和一个单独的医院。分娩量每年从 3500 到 48000 例不等。对所有 10 名受邀参与者进行了访谈。在三个医疗系统中制定了 19 种围产期紧急情况的清单。十个清单主题在所有三个机构都是相同的。参与者表示清单在危机期间改善了患者护理。这些工具被视为在临床角色之间促进共享心理模型、减少冗余和协调产科危机管理的机会。清单是由小团体制定的。清单的制定者促进了实施。参与者一致认为，模拟对于清单的完善和响应团队的有效使用至关重要。实施障碍包括临床医生的可用性有限。还有机会在围产期急救早期加强清单工作流程的整合。参与者表示，文化变革需要时间、积极实践、坚持、强化和过程测量。
本研究概述了在三个机构制定、实施和维持围产期急救清单的流程。参与者一致认为，多种并行实施策略为整合创造了文化转变。概述和具体的实施研究综合框架组件可用于为其他考虑实施围产期急救清单的人提供适应和可持续性的信息。
· 围产期急救清单可减少冗余并协调产科危机管理。· 围产期急救模拟对于清单的完善和有效团队使用至关重要。· 围产期急救清单的整合需要文化变革和过程测量。
