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Reducing preventable obstetric-related patient harm.
What Was the Client’s Challenge?
The North Carolina Quality Center partnered with the Virginia Hospital Association in southeastern US to reduce the incidence of preventable Obstetrical-related patient harm by 20%. Across North Carolina and Virginia, their maternal/fetal mortality rates ranked 42nd and 32nd respectively to the other States.
Why Did the North Carolina Quality Center Partner With Synensys?
Synensys had extensive experience using teamwork, simulation, and communication training based on high reliability principles to successfully reduce preventable harm during Obstetrical emergencies such as prolapsed cord, postpartum hemorrhage, shoulder dystocia, and neonatal resuscitations across military and civilian healthcare settings.
How Did We Solve the Problem?
Synensys provided monitoring and evaluation of teamwork and communications skills during critical event simulation drills with over 30 hospitals – teaching multidisciplinary practitioners the knowledge, skills, and attitudes necessary to support a local team simulation system to improve performance. We partnered with Laerdal Medical using state-of-art human patient simulators for experienced practitioner train-the-trainer program.
What Were the Results?
All Obstetrical harm was reduced by more than 20% in the 3-year program saving an estimated 150 patient lives. Obstetrical teams adopted a post C-section debriefing process that surfaced hundreds of small but significant defects in the local delivery systems which were improved using Plan-Do-Check-Act rapid cycle improvement methods taught through the program. Perceptions of safety culture, teamwork, and communication all improved significantly through the program duration – continuing to increase two years after the program was shifted to the local site owners during the sustainment period.