Opportunities to Foster Efficient Communication in Labor and Delivery Using Simulation.
2017; 7 (1): e44-e48
Obesity and Tobacco Cessation Toolkits: Practical Tips and Tools to Save Lives.
Obstetrics and gynecology
Introduction Communication errors are an important contributing factor in adverse outcomes in labor and delivery (L&D) units. The objective of this study was to identify common lapses in verbal communication using simulated obstetrical scenarios and propose alternative formats for communication. Methods Health care professionals in L&D participated in three simulated clinical scenarios. Scenarios were recorded and reviewed to identify questions repeated within and across scenarios. Questions that were repeated more than once due to ineffective communication were identified. The frequency with which the questions were asked across simulations was identified. Results Questions were commonly repeated both within and across 27 simulated scenarios. The median number of questions asked was 27 per simulated scenario. Commonly repeated questions focused on three general topics: (1) historical data/information (i.e., estimated gestational age), (2) maternal clinical status (i.e., estimated blood loss), and (3) personnel (i.e., "Has anesthesiologist been called?"). Conclusion Inefficient verbal communication exists in the process of transferring information during obstetric emergencies. These findings can inform improved training and development of information displays to improve teamwork and communication. A visual display that can report static historical information and specific dynamic clinical data may facilitate optimal human performance.
View details for DOI 10.1055/s-0037-1599123
View details for PubMedID 28255522
Maternal attachment insecurity is a potent predictor of depressive symptoms in the early postnatal period
JOURNAL OF AFFECTIVE DISORDERS
2016; 190: 623-631
Optimistic outlook regarding maternity protects against depressive symptoms postpartum
ARCHIVES OF WOMENS MENTAL HEALTH
2015; 18 (2): 197-208
Both obesity and smoking are public health burdens that together contribute to approximately one third of the deaths annually in the United States. In 2015, under the direction of Dr. Mark DeFrancesco, the American College of Obstetricians and Gynecologists convened two workgroups with the purpose of creating toolkits that bring together information that the obstetrician-gynecologist can use to address these preventable health problems. An Obesity Prevention and Treatment Workgroup and a Tobacco and Nicotine Cessation Workgroup developed toolkits on Obesity Prevention and Treatment (www.acog.org/ObesityToolkit)andTobaccoandNicotineCessation(www.acog.org/TobaccoToolkit). The toolkits contain specific talking points, counseling methods, and algorithms to address these health concerns in a supportive, efficient, and effective manner. By including these methods in practice, clinicians can help prevent the tragedy of early deaths caused by obesity, tobacco, and nicotine use.
View details for PubMedID 27824751
Lean management system application in creation of a postpartum hemorrhage prevention bundle on postpartum units.
Obstetrics and gynecology
2014; 123: 45S-?
The transition to motherhood is a time of elevated risk for clinical depression. Dispositional optimism may be protective against depressive symptoms; however, the arrival of a newborn presents numerous challenges that may be at odds with initially positive expectations, and which may contribute to depressed mood. We have explored the relative contributions of antenatal and postnatal optimism regarding maternity to depressive symptoms in the postnatal period. Ninety-eight pregnant women underwent clinician interview in the third trimester to record psychiatric history, antenatal depressive symptoms, and administer a novel measure of optimism towards maternity. Measures of depressive symptoms, attitudes to maternity, and mother-to-infant bonding were obtained from 97 study completers at monthly intervals through 3 months postpartum. We found a positive effect of antenatal optimism, and a negative effect of postnatal disconfirmation of expectations, on depressive mood postnatally. Postnatal disconfirmation, but not antenatal optimism, was associated with more negative attitudes toward maternity postnatally. Antenatal optimism, but not postnatal disconfirmation, was associated with reduced scores on a mother-to-infant bonding measure. The relationships between antenatal optimism, postnatal disconfirmation of expectations, and postnatal depression held true among primigravidas and multigravidas, as well as among women with prior histories of mood disorders, although antenatal optimism tended to be lower among women with mental health histories. We conclude that cautious antenatal optimism, rather than immoderate optimism or frank pessimism, is the approach that is most protective against postnatal depressive symptoms, and that this is true irrespective of either mood disorder history or parity. Factors predisposing to negative cognitive assessments and impaired mother-to-infant bonding may be substantially different than those associated with depressive symptoms, a finding that merits further study.
View details for DOI 10.1007/s00737-014-0446-3
View details for Web of Science ID 000351476400006
View details for PubMedID 25088532
Postpartum hemorrhage is the leading cause of maternal death worldwide. Lean management principles incorporate a family-centered improvement system making work more effective and safer.Application of lean management principles in development of the Postpartum Hemorrhage Care Bundle and the Postpartum Hemorrhage Prevention Bundle is an innovative approach to improving patient outcomes. Implementing a bundle with high reliability requires redesign of work processes, communication, infrastructure, and sustained measurement. A lean process is a set of interventions, each of which creates value for the customer. Lean is not a new concept, but relatively new to health care.Through simulation training over a 6-month period 100 registered nurses, physicians, and family representatives simulated the innovative approach developed by a multidisciplinary local improvement team (clinical microsystems methodology) in the maternity department of Lucile Packard Children's Hospital at Stanford. Simulation training was held at the nationally renowned Center for Advanced Pediatric and Perinatal Education. The local improvement team was able to demonstrate significant decreased response time for emergencies.Supply retrieval time decreased by 99.9%, physician response time decreased by 81%, and family-centered care increased by 100%. The Postpartum Hemorrhage Prevention Bundle could become the first national standard in prevention of postpartum hemorrhages on a postpartum unit.
View details for DOI 10.1097/01.AOG.0000447328.58883.1e
View details for PubMedID 24770195