Prevention of Failure to Rescue in Obstetric Patients: A Realist Review

Bernstein, Samantha; Kelechi, Teresa J.; Catchpole, Kenneth; Nemeth, Lynne S.

doi:10.1111/wvn.12531

Cited by 6 publications

(4 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another distinguishing theme—strong communication among clinical teams—is also emphasized in research on quality of care in obstetrics 20–28 and other specialties. 29–34 Communication and teamwork deficiencies are among the strongest predictors of surgical errors 35,36 and medical complications in adverse event or incident reports 31,37 and are key drivers of poor maternal and infant outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The Alliance for Innovation on Maternal Health patient safety bundles propose standardized, evidence-based practices, including standards for managing severe hypertension and cardiac disorders in pregnancy, obstetric hemorrhage, and safe reduction of primary cesarean delivery. 19 Another distinguishing theme-strong communication among clinical teams-is also emphasized in research on quality of care in obstetrics [20][21][22][23][24][25][26][27][28] and other specialties. [29][30][31][32][33][34] Communication and teamwork deficiencies are among the strongest predictors of surgical errors 35,36 and medical complications in adverse event or incident reports 31,37 and are key drivers of poor maternal and infant outcomes.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Distinguishing High-Performing From Low-Performing Hospitals for Severe Maternal Morbidity

Howell

Sofaer

Balbierz

et al. 2022

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

To investigate which organizational factors, policies, and practices distinguish hospitals with high compared with low risk-adjusted rates of severe maternal morbidity (SMM).METHODS: Using a positive deviance approach, this qualitative study included 50 semistructured interviews with health care professionals (obstetrics and gynecology chairs, labor and delivery medical directors, nurse managers, frontline nurses, physicians or nurses responsible for quality and safety, and chief medical officers) in four lowperforming and four high-performing hospitals in New York City. Hospital performance was based on risk-adjusted morbidity metrics from previous research. Major topics explored were structural characteristics (eg, staffing, cre-dentialing), organizational characteristics (eg, culture, leadership, communication, use of data), labor and delivery practices (eg, use of standardized, evidence-based practices, teamwork), and racial and ethnic disparities in SMM. All interviews were audiotaped, professionally transcribed, and coded using NVivo software. Researchers blinded to group assignment conducted qualitative content analysis. Researchers wrote analytic memos to identify key themes and patterns emerging from the interviews, highlight illustrative quotes, and draw qualitative comparisons between the two hospital clusters with different (but unrevealed) performance levels.RESULTS: Six themes distinguished high-performing from low-performing hospitals. High-performing hospitals were more likely to have: 1) senior leadership involved in day-to-day quality activities and dedicated to quality improvement, 2) a strong focus on standards and standardized care, 3) strong nurse-physician communication and teamwork, 4) adequate physician and nurse staffing and supervision, 5) sharing of performance data with nurses and other frontline clinicians, and 6) explicit awareness that racial and ethnic disparities exist and that racism and bias in the hospital can lead to differential treatment.CONCLUSION: Organizational factors, policies, and practices at multiple levels distinguish high-performing from low-performing hospitals for SMM. Findings illustrate the potential for targeted quality initiatives to improve maternal health and reduce obstetric disparities arising from delivery in low-performing hospitals.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Distinguishing High-Performing From Low-Performing Hospitals for Severe Maternal Morbidity

Howell

Sofaer

Balbierz

et al. 2022

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

show abstract

“…40% ( n = 37) of the realist reviews cited use of an advisory group at some stage (as per the working definition for this study, notably other terminology was often reported) [14–17, 25–61]. 60% ( n = 56) did not mention the use of an advisory group [62–117]. Of those that did not mention an advisory group, seven reviews [62–64] did report participant involvement that did not fulfill the criteria of an advisory group, i.e., participants were used as data sources but did not advise on the review.…”

Section: Resultsmentioning

confidence: 99%

Advisory groups in realist reviews: Systematically mapping current research and recommendations for practice

Power,

Dada,

Booth

et al. 2024

Cochrane Evidence Synthesis and Methods

View full text Add to dashboard Cite

IntroductionRealist reviews may involve groups or panels external to the research team who provide external and independent perspectives informing the review based on their experience of the topic area. These panels or groups are termed in this study as an “advisory group.” This study aims to map current practice of advisory groups in realist reviews and provide guidance for planning and reporting.MethodsA “best‐fit” framework synthesis methodology was used by first searching for a best‐fit framework and then conducting a systematic search to identify a sample of realist reviews and rapid realist reviews (RRRs) from the most recent year, 2021. Nine databases were searched: CINAHL Complete, Cochrane, Embase, ERIC, MEDLINE, PsycInfo, Social Services Abstracts, Sociological Abstracts, and Web of Science Core Collection. Screening and data extraction was conducted by two researchers. The chosen best‐fit framework (ACTIVE framework) informed the data extraction tool.ResultsOne hundred and seven reviews (93 realist reviews, 14 RRRs) were identified for inclusion. Of these, 40% (n = 37) of realist reviews and 71.5% (n = 10) of RRRs mentioned use of an advisory group, though there was considerable variation in terminology used. Individuals in advisory groups were involved at varying stages of the review and tended to bring experience in the topic area from the perspective of (i) a lived experience, i.e., patients, carers, family members (n = 15 realist reviews; n = 4 RRRs); (ii) professional experience, such as healthcare professionals (n = 20 realist reviews; n = 6 RRRs); or (iii) policy or research experience in the topic area (n = 19 realist reviews; n = 7 RRRs).ConclusionsThis study proposes a definition of advisory groups, considerations for advisory group use, and suggested items for reporting. The purpose of the advisory group should be carefully considered when deciding on their use in a realist review.

show abstract

“…In an attempt to mitigate against failure to rescue, it is assumed that a lack of or outdated training is the cause. As a result, the training of healthcare workers is often prioritised over other elements in the healthcare system, such as organisational, environmental, people, tasks, technology and tools factors that may equally impact healthcare delivery and outcomes [ 93 , 94 ].…”

Section: Discussionmentioning

confidence: 99%

A systematic review of behaviour change interventions to improve maternal health outcomes in sub-Saharan Africa

Muriithi,

Banke-Thomas,

Forbes

et al. 2024

PLOS Glob Public Health

View full text Add to dashboard Cite

The rate of decline in the global burden of avoidable maternal deaths has stagnated and remains an issue of concern in many sub-Saharan Africa countries. As per the most recent evidence, an average maternal mortality ratio (MMR) of 223 deaths per 100,000 live births has been estimated globally, with sub-Saharan Africa’s average MMR at 536 per 100,000 live births—more than twice the global average. Despite the high MMR, there is variation in MMR between and within sub-Saharan Africa countries. Differences in the behaviour of those accessing and/or delivering maternal healthcare may explain variations in outcomes and provide a basis for quality improvement in health systems. There is a gap in describing the landscape of interventions aimed at modifying the behaviours of those accessing and delivering maternal healthcare for improving maternal health outcomes in sub-Saharan Africa. Our objective was to extract and synthesise the target behaviours, component behaviour change strategies and outcomes of behaviour change interventions for improving maternal health outcomes in sub-Saharan Africa. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Our protocol was published a priori on PROSPERO (registration number CRD42022315130). We searched ten electronic databases (PsycINFO, Cochrane Database of Systematic Reviews, International Bibliography of Social Sciences, EMBASE, MEDLINE, Scopus, CINAHL PLUS, African Index Medicus, African Journals Online, and Web of Science) and included randomised trials and quasi-experimental studies. We extracted target behaviours and specified the behavioural interventions using the Action, Actor, Context, Time, and Target (AACTT) framework. We categorised the behaviour change strategies using the intervention functions described in the Behaviour Change Wheel (BCW). We reviewed 52 articles (26 randomized trials and 26 quasi-experimental studies). They had a mixed risk of bias. Out of these, 41 studies (78.8%) targeted behaviour change of those accessing maternal healthcare services, while seven studies (13.5%) focused on those delivering maternal healthcare. Four studies (7.7%) targeted mixed stakeholder groups. The studies employed a range of behaviour change strategies, including education 37 (33.3%), persuasion 20 (18%), training 19 (17.1%), enablement 16 (14.4%), environmental restructuring 8 (7.2%), modelling 6 (5.4%) and incentivisation 5 (4.5%). No studies used restriction or coercion strategies. Education was the most common strategy for changing the behaviour of those accessing maternal healthcare, while training was the most common strategy in studies targeting the behaviour of those delivering maternal healthcare. Of the 52 studies, 40 reported effective interventions, 7 were ineffective, and 5 were equivocal. A meta-analysis was not feasible due to methodological and clinical heterogeneity across the studies. In conclusion, there is evidence of effective behaviour change interventions targeted at those accessing and/or delivering maternal healthcare in sub-Saharan Africa. However, more focus should be placed on behaviour change by those delivering maternal healthcare within the health facilities to fast-track the reduction of the huge burden of avoidable maternal deaths in sub-Saharan Africa.

show abstract

Prevention of Failure to Rescue in Obstetric Patients: A Realist Review

Cited by 6 publications

References 50 publications

Distinguishing High-Performing From Low-Performing Hospitals for Severe Maternal Morbidity

Distinguishing High-Performing From Low-Performing Hospitals for Severe Maternal Morbidity

Advisory groups in realist reviews: Systematically mapping current research and recommendations for practice

A systematic review of behaviour change interventions to improve maternal health outcomes in sub-Saharan Africa

Contact Info

Product

Resources

About