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Using Hourly Time-Outs and a Standardized Tool to Promote Team Communication, Medical Record Documentation, and Patient Satisfaction During Second-Stage Labor

Wood, Jessica, DNP, WHNP-BC, RNC-OB; Stevenson, Eleanor, PhD, RN

MCN: The American Journal of Maternal/Child Nursing: July/August 2018 - Volume 43 - Issue 4 - p 195–200
doi: 10.1097/NMC.0000000000000442

Background: During labor, effective communication and collaboration among the healthcare team is critical for patient safety; however, there is currently no standard for communication and documentation of the plan of care as agreed upon by healthcare team members and the woman in labor.

Objectives: The goal of this project was to increase consistency in communication and collaboration between clinicians and laboring women during second-stage labor.

Methods: An hourly “time-out” meeting of all healthcare team members was initiated for all women during second-stage labor. A documentation tool was implemented to ensure regular and clear communication between the clinical team and laboring women. Data were collected via medical review of cases of second-stage labor lasting more than 2 hours (n = 21 in the pre-implementation group; n = 39 for 3 months postimplementation; and n = 468 patients for 2 years post-implementation). Surveys were conducted of the clinical team (n = 40) and patients (n = 28).

Results: Following implementation, documented agreement of the plan of care increased from 14.3% before the project to 82.1% 3 months after implementation and remained at 81.6% 2 years after implementation. All nurses who participated in the survey reported a clear understanding of how and when to complete necessary medical record documentation during second-stage labor. The providers viewed the project favorably. Most women (92.9%) reported satisfaction with their experience. This project enhanced collaborative communication between members of the clinical team and laboring women and improved patient satisfaction. The improvements were sustainable over a 2-year period.

This quality improvement project focused on a standardized process for medical record documentation and for communication among clinical team members and the laboring woman during second stage labor. A key aspect was an hourly time-out beginning at the start of second stage labor. Findings suggest these methods collectively can improve medical record documentation, enhance patient satisfaction, and promote patient safety.

Jessica Wood is an Assistant Professor, Norwich University, School of Nursing, Northfield, VT. The author can be reached via e-mail at

Eleanor Stevenson is an Associate Professor, Duke University, Durham, NC.

The authors declare no conflicts of interest.

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