Author(s): Heather Walker, DNP, RN, RTS-CBC, RNC-IAP, C-ONQS, C-EFM, RNC-OB
Educator
Memorial Hermann Cypress

I have 28 years' experience as an OB nurse in Mother/Baby, High Risk Antepartum, Labor and Delivery, Case Management, and Education. Through this experience I have been a part of many quality and process improvement initiatives at multiple facilities. My goal is to create an environment and that allows nurses to have access to the best information and processes to allow them to provide the best care for their patients. Having streamlined processes that encourage communication, clear lines of escalation, and mutual respect for all healthcare team members is the goal for all projects that I undertake.

Competency Domain: Population Health & Care Transitions

Description: This is a quality improvement project to identify best practices for collaboration between hospitals and birth centers/midwives to decrease transfer times and improve maternal and neonatal outcomes. Inter-professional training, provider pre- and post- surveys, and a new transfer process based on feedback and best-practice evidence were implemented to determine if a streamlined process and improved communication would improve outcomes. Post-intervention report doubled, there were no maternal/neonatal adverse outcomes, and staff satisfaction with the new process showed a statistically significant improvement. Standardized processes for communication and transfer that is streamlined, respectful, and patient centered can improve patient outcomes and provider satisfaction. Problem: The purpose of this quality improvement project was to identify best practices in collaboration between birth centers/midwives and hospitals, improve communication and improve transport times of women and/or neonates requiring a higher level of care, and to decrease maternal and neonatal morbidity and mortality. Measurement: Inter-professional training was provided to improve teamwork and collaboration, provider pre- and post- surveys using Microsoft Forms, and a transfer process was created and implemented to determine if a streamlined process and improved communication would improve outcomes. Pre- and post-intervention chart audits were performed manually for baseline and ongoing data. Analysis: This project was completed using a PDSA process. Chart audits were completed on every patient from a birth center/midwife prior to, during, and post intervention. Survey results were analyzed using SPSS software Crosstabs and Chi-Sqaure tests. Patient outcome results were evaluated using SMM definitions and totals pre- and post-intervention. Implementation: A new communication and throughput tool was created based on provider feedback and best practice evidence. Obstacles included lack of engagement from midwives, difficulty engaging physicians, and receiving feedback from midwives that transferred patients to our facility. Results/Discussion After implementation of the project there were no adverse maternal or neonatal events related to transfer from a birth center/midwife. We created an easy-to-follow process map with clear lines of communication, escalation, and discharge processes to ensure that patients who were see the midwife after discharge had records.

Evaluation: Complete Poster Evaluation