I’ve had this idea brewing for a while. It’s taken a while for it to form shape, to work its way from a random niggling thought in my head to something I can articulate with the passion and determination it inspires in me.
On labor and delivery: There is an “I” in team.
Yes, I know. I said something inflammatory. I can almost see heads shaking as you wonder how I could suggest something so preposterous. Let me explain.
I enjoy working at community hospitals. I like the idea of knowing the other department members and all the nurses on L&D and postpartum. There is a sense of all of us “in the same boat,” so to speak. Colleagues are quick to lend a hand in a hairy situation, whether they are in your group or not. You can see, hear and be inspired by another OB’s quick thinking or saddened by the catastrophic situations we sometimes can’t avoid.
But what about the ones we can avoid?
As morbidity and mortality rates for childbirth in the U.S. continue to climb, we are looking to find ways out of this quagmire of bad outcomes. And here’s what I’ve learned. It is not enough for one obstetrician to be engaged. Or one nurse. Or one department.
“I” is imperative.
The first “I” is for “investment.”
In a world where EMRs rule doctors’ lives, burnout is at an unprecedented high, nursing shortages are at a frightening level, and patients’ individual risk factors continue to multiply — how do we keep every team member invested?
There is an unbelievable, almost surreal impotence one feels while watching a new mother bleed to death, despite all of one’s training and technical skill.
Over the last year, our hospital has had multiple life-threatening hemorrhages. And over the course of that year, I’ve seen a change. More nurses than ever before are engaged in the idea of checklists and safety bundles. Nursing administration has redoubled its efforts to disseminate hemorrhage information through drills and mock codes. More OBs are jumping in to help each other save lives. And we are working together, better than ever before, at our community hospital.
The perspective has changed from hemorrhage is a bad thing that happens to a few unfortunate people to something that could happen to any of us or our loved ones at our institution — or any institution. We, as a team, are now more invested. What if we developed ways to recognize the teams working hard to change the culture and environment? Would that not further the individual investment?
The second “I” is for “interdisciplinary involvement.”
While seemingly logical, sometimes the systems challenges we face do not bare their teeth in the bright light of day. They simmer in a cauldron of technological obstacles and bubble over into communication lapses in the deepest, darkest shadows of the night, when we are suboptimally staffed, and every room on the unit is full. Conducting root cause analyses and debriefs allow every member to voice their triumphs and concerns at the end of a rough case.
But this is not enough.
In most hospitals, labor and delivery is sequestered in its own space and other services (blood bank, interventional radiology, respiratory therapy, and the ICU team) may not even know where the unit is. “Mega-code” drills allow us the opportunity to identify potential gaps in communication or technology limitations: turnaround time for lab results and even issues with accessing or moving patients (or blood products, instruments, equipment) to and from the unit, all before we’re in dire straits, with nowhere to turn.
Another important factor — the institutional administration’s role and engagement to improve outcomes, without which the funding and manpower will remain insufficient. We are fortunate to have a listening ear at our institution, which is not available everywhere. Interdisciplinary involvement is incomplete without administrative buy-in.
The third “I” is for “improvement.”
Quality improvement that is. Ongoing data collection that tells us, beyond a shadow of a doubt, that we are better than we were yesterday and worse than tomorrow. Short CME reviews, perhaps at the department meeting, so all providers are aware of the most recent data.
Improvement is best seen by those it affects directly. Our staff has shown a poetic symphony of teamwork in the most recent hemorrhage, versus the first one, over the course of less than one year. Behaviors are best learned by repetition, not memorization. In the frenetic chaos of a life-threatening hemorrhage, being prepared with all systems go (and tested to be a go) optimizes our ability to provide safe obstetric care.
And so, I repeat, on labor and delivery, there is an “I” in team.
But it is the “I” that makes us greater.
Preeti Jhaveri is an obstetrician-gynecologist.
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