Obstetric Quality and Safety
Poster Session 4
.jpg "Monica Sosa, MD photo")
Monica Sosa, MD
Resident
University of Washington Medical Center
Seattle, WA, United States
Nadine Martinez, DNP, RN
Perinatal Clinical Nurse Specialist
University of Washington Medical Center
Seattle, WA, United States
La Vone Simmons, MD
University of Washington Medical Center
Seattle, WA, United States
Ralph N. Burns, MD
Maternal Fetal Medicine Fellow
University of Washington Medical Center
Seattle, WA, United States
To assess if a live visual metric in common work areas would improve timely treatment of severe hypertension (sHTN) episodes, as defined by the Society for Maternal-Fetal Medicine’s suggested sHTN quality metric.
Study Design:
This is a single institution prospective observational quality improvement study. The visual metric is a g-chart, converted to a ‘scoreboard’-poster that displays (1) the number of consecutive days sHTN episodes were managed appropriately and (2) the best streak without metric failure. The AdaptX platform tracked these episodes. On March 9, 2023 the visual metric was displayed in the Labor and Delivery and Postpartum multidisciplinary team-rooms. The primary outcome was the rate of timely treatment of sHTN episodes, aiming to increase our success rate from 93% to 100% in the following five months post-implementation.
Results:
In the 23 months prior to implementation, from April 1, 2021 to March 8, 2023, there were a total of 535 sHTN episodes, 93.6% with successful timely treatment. This represented an average of 18 days between metric failures (+/- 22.4; upper control limit 189) and a median of 8 sHTN cases between failure events (IQR 10; upper control limit 51). In the five months after implementation of the visual metric, from March 9, 2023 to August 6, 2023, there were a total of 102 sHTN episodes, 99.0% with successful timely treatment. Only one failure occurred in this time period, with a best streak of 104 consecutive days (74 consecutive cases) without metric failure. The poster continues to be regularly updated.
Conclusion:
A low cost, live visual metric in common work areas appears to be a promising motivator for multi-disciplinary clinical performance to enhance patient safety. We hope to implement standing order sets that would improve timely treatment of sHTN episodes, assess staff attitudes after implementation of the visual metric and further analyze the location and time of day in which metric failures occurred.