Introduction In-situ interprofessional emergency team training improves participants’ with confidence and knowledge and identifies latent safety threats. This study examined the impact of a structured debrief on an interprofessional perinatal team’s ability to identify latent safety threats and assess competency in managing perinatal emergencies. It was hypothesized that latent safety threats would be reduced and checklist compliance would increase during subsequent in-situ perinatal team training. Methods Two in-situ training sessions were held six months apart. The perinatal emergency response team provided care for a standardized patient with preterm twin gestation. Each session included off-ward delivery and resuscitation of the first infant, transportation to appropriate inpatient units, cesarean delivery, and resuscitation of the second twin. Postpartum hemorrhage ensued, requiring massive transfusion protocol activation. Medical experts assessed team performance with critical action checklists. A structured debrief identified latent safety threats, developed action plans, and reviewed checklist compliance. Checklist compliance rates were analyzed using a z-ratio test. Results The first training session: seven teams (75 staff) completed 75% (292/391) critical action checklist items and identified 34 latent safety threats. Second training session: four teams (45 staff) completed 89% (94/106) critical action checklist items. Ten latent safety threats were mitigated during the second session. Utilizing a z-ratio, a significant difference was detected between the overall checklist compliance rates of the two sessions, z = -3.069, p = .002. Post-hoc power calculation was <10%. Conclusions In-situ interprofessional perinatal emergency team training is feasible, identifies latent patient safety threats, and may improve team competency.

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Objective The study aimed to describe the postmortem investigation patterns for perinatal deaths and compare the degree of investigation between stillbirths and early neonatal deaths. Study Design We conducted a single-center retrospective review of all perinatal deaths from 2011 to 2017. Perinatal death was defined as intrauterine fetal death at ≥20 weeks' gestation, plus neonatal deaths within the first 7 days of life. Rates of postmortem investigation were compared. Results There were 97 perinatal deaths, with 54 stillbirths (56%) and 43 neonatal deaths (44%). Stillbirths were significantly more likely to receive autopsy (p = 0.013) and postmortem genetic testing (p = 0.0004) when compared with neonatal deaths. Maternal testing was also more likely in stillbirths than neonatal deaths. A total of 32 deaths (33%) had no postmortem evaluation beyond placental pathology. Conclusion Investigation following perinatal death is more likely in stillbirths than neonatal deaths. Methods to improve postmortem investigation following perinatal death are needed, particularly for neonatal deaths. Key Points

R esearchers at the Children's Hospital of Chicago sought to determine the rate of unfilled prescriptions among Medicaid-insured patients aged 0 to 24 years who received care at 2 large, urban, pediatric primary care clinics in Chicago over a period of 26 months. One clinic was staffed by residents and their preceptors and the other by residents and full-time academic pediatricians who saw their own patients when not supervising residents. Both clinics used the same electronic medical record (EMR), and midway through the study period both clinics' EMR acquired the functionality of sending prescriptions electronically to a pharmacy (e-prescription). Clinic EMRs were reviewed to obtain data on prescription ordering as well as associated clinical (well child visit vs sick visit) and patient demographic data (race/ethnicity, age, and gender). Prescriptions were divided into 8 medication categories (asthma/allergy, dermatologic, analgesics/antipyretics, oral antiinfectives, topical anti-infectives, nutritional, gastrointestinal, and other). Prescription data were matched with claims data from the Illinois Medicaid database to determine the rate of filled prescriptions.A total of 4,833 unique patients who were given 16,953 prescriptions were included in the study analyses. Most patients were Hispanic or African American and <11 years old. In total, Medicaid claims data indicated that 78.1% of these prescriptions were filled. There was a significant difference in the rate of filled prescriptions by medication category. Oral anti-infectives had the highest rate of being filled (91.2%) and nutritional supplements had the lowest rate (64.7%). African American and Hispanic patients were significantly more likely to fill prescriptions than white patients, and prescriptions given at sick visits were more likely to be filled than prescriptions given at well child visits. E-prescriptions were also significantly more likely to be filled than paper ones.The authors conclude that prescription nonadherence is not uncommon and associated with patient factors, visit type, and prescribing methods. Dr Haischer-Rollo has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The issue of unfilled medications has been a concern of health care providers. Previous studies have shown that overall rates of nonadherence may be as high as 50%. 1-3 The authors of this study document the extent of nonadherence in a Medicaid-insured primary care pediatric population and shed light on the factors that influence the filling of prescriptions. Although previous studies have shown that economics plays a large role in medication adherence, this study only included Medicaid-insured patients and therefore largely removed cost as a barrier. 2,3 The fact that over 20% of prescriptions went unfilled is noteworthy.The results of this study highlight several nondemographic factors associated with prescription nonadherence that deserve furt...