Cesarean Section Complications, Communication, Multidisciplinary, Maternal Complication of Pregnancy, Pregnancy Complications
Conditions
Keywords
Quality Improvement, Program Evaluation, Quality Assurance, Feasibility, Acceptability
Brief summary
The purpose of this study is to evaluate the feasibility of a pilot project to improve communication and teamwork and to increase vaginal delivery rates at hospital in the United States
Detailed description
The purpose of this study is to evaluate the feasibility of a pilot project to improve communication and teamwork and to increase vaginal delivery rates at hospital in the United States. TeamBirth is a rigorously designed care process to improve care and SDM across the full care team, which includes the patient, their support person(s), nurse and physician or midwife, by ensuring reliability for best practices in communication and teamwork during labor and delivery. TeamBirth aims to operationalize best practices in communication and clinical care from the major professional organizations in obstetrics, including the American College of Obstetricians & Gynecologists (ACOG), Society for Maternal-Fetal Medicine (SMFM), American College of Nurse-Midwives (ACNM), and Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN), to ensure these practices are occurring consistently throughout labor. Key TeamBirth practices include: 1. Promoting the roles of the laboring patient, nurse, and delivering provider as members of the care team with equally valuable input for SDM, 2. Eliciting the patient's preferences, symptoms, and subjective experiences and integrating them with clinical data to inform patient care plans, 3. Distinguishing statuses and care plans for the mother, fetus, and labor progress, and 4. Setting shared expectations for the next planned evaluation.
Interventions
BEHAVIORALExposed study site
The study sites will pilot the Team Birth Project designed to improve team communication (between providers, as well as providers and patients). The project includes three key implementation steps that involve: preparing local sites for the implementation of the project; training and coaching on the use of the tools; and sustainment through peer coaching and data feedback. A mixed methods approach will be used to assess acceptability and feasibility, including: (1) clinician surveys and interviews, (2) implementation team focus groups, and (3) patient surveys.
Sponsors
Brigham and Women's Hospital
Harvard School of Public Health (HSPH)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Clinician Participant Inclusion Criteria: * All clinicians who have practice privileges at a study site Clinician Participant
Exclusion criteria
* None Implementation Team Participant Inclusion Criteria: * Champions, super-users and others who have been involved in the implementation of Team Birth Project at a study site Implementation Team Participant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent of Clinicians Recommending TeamBirth Project | The window begins on the 180th day to the 270th day from the start date at each site (180 days to 270 days). If clinicians complete more than one survey in the window, we will use the first one. | At the project midline, percent of clinicians (physicians, midwives, and nurses) who would definitely or probably recommend the Team Birth project tools for use in other labor and delivery units. |
| Percent of Patients With the Role They Wanted in Decision-Making | The window begins on the 180th day to the 270th day from the start date at each site (180 days to 270 days). Patients were only offered the survey once within the window. | At the project midline, percent of patients who definitely or somewhat had the role they wanted in making decisions about their labor, among patients who wanted to make collaborative decisions with clinicians. |
Countries
United States
Participant flow
Recruitment details
Clinicians: All nurses, midwives, and obstetricians in the participating units were invited to complete surveys using online links/QR codes; Patients: All patients \>= 18 years (except Saint Francis where patients \>= 15 years were included) who did not have a fetal demise or scheduled cesarean delivery were eligible during their postpartum stay
Pre-assignment details
N/A for single group assignment
Participants by arm
| Arm | Count |
|---|---|
| Implemented Health Facility Health facility that has piloted the Team Birth Project
Exposed study site: The study sites will pilot the Team Birth Project designed to improve team communication (between providers, as well as providers and patients). The project includes three key implementation steps that involve: preparing local sites for the implementation of the project; training and coaching on the use of the tools; and sustainment through peer coaching and data feedback. A mixed methods approach will be used to assess acceptability and feasibility, including: (1) clinician surveys and interviews, (2) implementation team focus groups, and (3) patient surveys. | 5,217 |
| Total | 5,217 |
Baseline characteristics
| Characteristic | Implemented Health Facility |
|---|---|
| Age, Customized Age 20 - 24 years old | 443 Participants |
| Age, Customized Age 25 - 29 years old | 1105 Participants |
| Age, Customized Age 30 - 34 years old | 1439 Participants |
| Age, Customized Age 35 - 39 years old | 707 Participants |
| Age, Customized Age 40 years old or older | 107 Participants |
| Age, Customized Age Under 20 years old | 79 Participants |
| Age, Customized Age Unknown or Not Reported | 1337 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 325 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 3599 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1293 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants |
| Race (NIH/OMB) Asian | 568 Participants |
| Race (NIH/OMB) Black or African American | 167 Participants |
| Race (NIH/OMB) More than one race | 539 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 9 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1370 Participants |
| Race (NIH/OMB) White | 2563 Participants |
| Region of Enrollment United States | 5217 participants |
| Sex/Gender, Customized Gender Female | 3924 Participants |
| Sex/Gender, Customized Gender Male | 0 Participants |
| Sex/Gender, Customized Gender Unknown or Not Reported | 1293 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 662 / 7,716 | 50 / 3,737 |
| serious Total, serious adverse events | 328 / 14,286 | 260 / 11,063 |
Outcome results
Primary
Percent of Clinicians Recommending TeamBirth Project
At the project midline, percent of clinicians (physicians, midwives, and nurses) who would definitely or probably recommend the Team Birth project tools for use in other labor and delivery units.
Time frame: The window begins on the 180th day to the 270th day from the start date at each site (180 days to 270 days). If clinicians complete more than one survey in the window, we will use the first one.
Population: Eligible clinicians (physicians, midwives, and nurses) who responded to a survey during the outcome measure time frame
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Implemented Health Facility | Percent of Clinicians Recommending TeamBirth Project | Definitely | 254 Participants |
| Implemented Health Facility | Percent of Clinicians Recommending TeamBirth Project | Probably | 83 Participants |
| Implemented Health Facility | Percent of Clinicians Recommending TeamBirth Project | Maybe | 25 Participants |
| Implemented Health Facility | Percent of Clinicians Recommending TeamBirth Project | Probably Not | 13 Participants |
| Implemented Health Facility | Percent of Clinicians Recommending TeamBirth Project | Definitely Not | 0 Participants |
Primary
Percent of Patients With the Role They Wanted in Decision-Making
At the project midline, percent of patients who definitely or somewhat had the role they wanted in making decisions about their labor, among patients who wanted to make collaborative decisions with clinicians.
Time frame: The window begins on the 180th day to the 270th day from the start date at each site (180 days to 270 days). Patients were only offered the survey once within the window.
Population: Eligible patients who responded to a survey and wanted to make collaborative decisions with clinicians during the outcome measure time frame
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Implemented Health Facility | Percent of Patients With the Role They Wanted in Decision-Making | Yes, definitely | 726 Participants |
| Implemented Health Facility | Percent of Patients With the Role They Wanted in Decision-Making | Yes, somewhat | 68 Participants |
| Implemented Health Facility | Percent of Patients With the Role They Wanted in Decision-Making | No | 5 Participants |
| Implemented Health Facility | Percent of Patients With the Role They Wanted in Decision-Making | Don't know / no opinion | 4 Participants |
| Implemented Health Facility | Percent of Patients With the Role They Wanted in Decision-Making | Prefer not to answer | 2 Participants |