Institution-Specific Perinatal Emergency Checklists: Multicenter Report on Development, Implementation, and Sustainability

Abstract

Background: The American College of Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine endorses 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. Objective: To investigate the development and implementation of perinatal emergency checklists in diverse hospital settings in the United States. Methods: A qualitative study was conducted individually with clinicians from three healthcare systems. The participants developed and implemented institution-tailored perinatal emergency checklists. Interview transcriptions were coded using the Consolidated Framework for Implementation Research. Results: The study sites included two healthcare systems and one individual hospital. Delivery volumes ranged from 3,500 to 48,000 deliveries a year. Interviews were conducted with all ten participants approached. Checklists for 19 perinatal emergencies were developed at the three healthcare 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. Conclusion: 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.

The importance of simulation-based multi professional training in obstetric anesthesia: an update

“…A variety of organizations have developed cognitive aids for management of obstetric emergencies including the California Maternal Quality Care Collaborative (CMQCC), the Newton-Wellesley Hospital in Boston, and Stanford University Hospital [23,24 ▪ ]. The group at Stanford developed a checklist for use during management of PPH based on consensus guidelines described by ACOG and the Royal College of Obstetricians and Gynecologists [25].…”