When a 23-year old pregnant woman presented to an emergency department in Colorado Springs with symptoms of stroke, University of Colorado Hospital (UCHA) was immediately consulted. She was 36 weeks pregnant and needed to be transferred. Multiple teams sprung into action, including neurology, neurosurgery, interventional radiology, anesthesia, and the entire obstetrics care team. Thanks to their collective efforts, the soon-to-be mom fully recovered from the stroke. She was sent home to Colorado Springs just a few days later, still pregnant and eagerly anticipating the delivery of a full-term, healthy baby.
“It was my one of my most gratifying moments as a doctor. And it’s clear to me that outcomes like this simply don’t occur if your teams are not communicating effectively,” said Julie Scott, MD, medical director of labor and delivery at UCHA.
Good team communication, Dr. Scott asserts, can make or break any patient encounter. It’s the reason she and her team have been working to maximize effective communication between the many care providers who care for mom and baby in her department.
“Women and infant services are unique in that we’re all working together intimately at the bedside,” she explained. “There are a lot of moving parts and it’s all very integrated, so in order to provide the best care, it is imperative we all work together.”
Patrick Kneeland, MD, medical director for patient and provider experience at UCHA, believes Dr. Scott’s work exemplifies the hospital’s Standards of Excellence. “Dr. Scott’s leadership in the development of an interdisciplinary improvement team around patient safety events has represented an impressive cultural overhaul,” he said, adding that it’s clear within her department that all team members have a mindset of patient-centered care.
Most recently, Dr. Scott and her team have been working on standardized communication. With so many risk events related to communication errors, scripting has become a priority for the obstetrics, newborn, and nursing teams.
Using the Situation, Background, Assessment and Recommendation—or SBAR technique—team members have been working to standardize the way they speak to each other, which ensures the critical information is structured in a way that’s understood.
“We want to avoid circumstances that result in statements like, ‘I thought I told you that’ or ‘I thought you understood,’” she said. “As a team, we’re working to recognize where ambiguity occurs and taking steps to mitigate it.”
If a misunderstanding does occur, the team takes part in interdisciplinary peer reviews, a system that Dr. Scott helped implement.
“I work with a quality team of nurses and providers. Once there was a mechanism in place for reporting, the team saw it as an opportunity to drive quality care.”
Since the system has been in place, there’s been a shift in the department’s culture related to the handling of patient safety events.
“We’re now focused on understanding the cause of such events and moving forward.” Dr. Scott cites an added bonus to her department’s shift in culture.
“When people talk openly about improving quality, they tend to be more innovative with ideas that improve quality and efficiency.”
Dr. Scott again credits the excellence of her team for their quality and safety efforts. And this added focus on clinical excellence comes at just the right time, as the team prepares for a continued surge in the number of patients cared for by their service as well as changing patient demographics. She explains that in recent years, the health status of the women they see has deteriorated.
“This team takes care of a lot of very sick women, and they do so incredibly well,” she said. “Not that I’m surprised. They’re the best of the best.”
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