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Healthcare Journal of Baton Rouge
| September / October 2008 Issue | healthcarejournalbr.com
result of medical errors. What many critics forgot, however, is
that these errors are often made by highly skilled professionals
and are generally the result of system failures, not substandard
individual performance. Could it be possible to do a better job in
labor and delivery?
Woman's Hospital is one of 57 hospitals participating in the
Institute of Health Care Improvement's Perinatal Collaborative.
The Institute of Health Care Improvement (IHI) is an independ-
ent not-for-profit organization helping to lead the improvement
of healthcare throughout the world. Woman's Hospital's goal is
to reduce perinatal morbidity to three in 1,000 births. Idealized
Design of Perinatal Care is an innovative project based on the
principles of reliability science. Reliability science is used at
nuclear power plants and on aircraft carriers–areas where failure
is not an option. The Idealized Design model focuses on compre-
hensive redesign to enable Woman's Hospital's labor and deliv-
ery to perform substantially better in the future than the best it
can do at present.
The best defense against medical error–and indeed for providing
the best care for patients–is prevention or minimization of harm
whenever possible, through adherence to evidence-based prac-
tice guidelines. The challenge is ensuring that these guidelines
are used consistently. The four key components of the Perinatal
Care Model are:
1. The development of reliable clinical processes to man-
age labor and delivery;
2. The use of principles that improve safety (i.e.,
preventing, detecting, and mitigating errors);
3. The establishment of prepared and activated care
teams that communicate effectively with each other
and with mothers and families; and
4. A focus on mother and family as the locus of control during
labor and delivery.
In the labor and delivery department at Woman's Hospital we are
using bundles of care that have been shown to reduce harm. A
perinatal bundle is a group of evidence-based interventions relat-
ed to care in labor and delivery that, when executed together,
result in better outcomes than when implemented individually.
Harm to the mother or the baby in labor and delivery is often
associated with the use of Pitocin, a medicine given to mothers
to make their contractions stronger. The goal of the perinatal
bundles is to reduce the risk of a bad outcome when inducing
labor, or augmenting labor, with Pitocin. Experience from the
use of bundles in other clinical areas, such as care of the venti-
lated patient, has shown that reliably applying these evidence-
based interventions can dramatically improve outcomes. The
assumption of this innovative work is that the use of bundles in
the delivery of perinatal care will have a similar effect.
Poor communication among providers and with patients con-
tributes to care that is less than optimal. In one study, more than
one-third of adverse events were associated with communication
problems ranging from basic miscommunication among
providers, to misunderstanding because of a lack of common ter-
minology, to delays in communication, and to a total absence of
communication. Part of the Perinatal Collaborative's focus is on
improving communication in labor and delivery. The SBAR
(Situation-Background-Assessment-Recommendation) tech-
nique used at Woman's Hospital provides a framework for com-