AHRQ Tools Improve Care, Safety for St. Luke’s University Health Network Obstetric Patients

St. Luke’s University Health Network—a non-profit, integrated network providing services at nine hospitals and more than 300 sites in Pennsylvania and New Jersey—is improving the culture of safety in its obstetrics (OB) units by using a combination of AHRQ’s Surveys on Patient Safety Culture™ Hospital Survey (HSOPS) and TeamSTEPPS®. The network also used elements of AHRQ’s Comprehensive Unit-based Safety Program (CUSP) and Toolkit for Reducing Central Line-Associated Blood Stream Infections (CLABSI) in developing a CLABSI checklist to improve care in the neonatal intensive care unit (NICU).

Initially, the OB unit—a high-risk area—was the focus for improvement efforts. Using the AHRQ hospital culture survey beginning in 2008 with OB staff allowed St. Luke’s to discover opportunities to improve teamwork and communications. Because management found the survey produced valuable information, they expanded the survey to include all staff members in the network.

Armed with survey data, the health system then launched TeamSTEPPS training for its employees. TeamSTEPPS, developed jointly by AHRQ and the Department of Defense, is an evidence-based set of teamwork tools aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.

As a result of the TeamSTEPPS training and new procedures, the OB staff’s views of the hospital’s safety culture improved significantly. For example, the staff’s overall perception of safety jumped from 45 percent positive in 2008 to 81 percent positive in 2014 on HSOPS.

During the past decade, St. Luke’s has addressed a wide range of safety issues related to obstetric care. These efforts have succeeded in decreasing its early elective delivery rate from 17 percent in 2008 to zero in 2015. NICU admissions were also reduced, thus improving infants’ outcomes. As a result, the NICU realized approximately $79,000 in direct cost savings.

Leadership from two campuses, St. Luke’s Allentown and Bethlehem Hospitals, both of which have OB units, participated in bimonthly meetings early on to ensure a standardized approach to improvement, according to Kathy Nunemacher M.S.N., R.N., St. Luke Health Network’s director of data governance and reporting. At the time of the initiative, she served as the coordinator for clinical quality improvement in the women’s and children’s and oncology service lines.

“We kept leaders and staff in the loop with a variety of communications methods: our OB performance improvement committee, grand rounds, unit meetings, and administrative and department meetings,” she said.

Sharing hospital culture survey data from AHRQ’s HSOPS helped encourage OB teams to make positive changes, Nunemacher explained. Hospital leaders assembled monthly team meetings with PowerPoint presentations, held management meetings with updates, and reported standings on HSOPS results during TeamSTEPPS training to show before-and-after scores once TeamSTEPPS training was implemented.

Nunemacher said the St. Luke’s OB team customized and continues to use the following elements to maximize patient safety:

• Operational/management initiatives:
  • An algorithm to manage Category II fetal heart rate patterns.
  • OB hemorrhage task force.
  • Designation of OB clinical risk manager.
• Classes/training:
  • “My elearning” TeamSTEPPS classes.
  • Revised prenatal class curriculum.
  • Simulation training program for the entire care team.
• Checklists/guidelines:
  • Preeclampsia guidelines.
  • Nursing documentation checklists.

Nunemacher noted that system leaders use HSOPS to give feedback to staff on their areas of strength and weakness. As a result of the positive experience in the OB units, St. Luke’s network has trained all inpatient and some outpatient staff members on TeamSTEPPS principles. This practice helps the entire staff remain focused on improving safety and sustaining improvement in the safety culture, she explained.

“TeamSTEPPS is now part of all of our new hire orientation,” Nunemacher said. “It has been particularly rewarding to see teams throughout the hospital customize the TeamSTEPPS curriculum to make it relevant to their respective clinical areas, such as new resident orientation.

“Our goal now is to roll out TeamSTEPPS refresher classes to all campuses, including our newly acquired campuses. A tenth hospital campus is planned to open in late 2019.”