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Safe Passage: Improving the Transition of Care Between Triage and Labor and Delivery

Lee, Daniel D., MD; Colwill, Alyssa C., MD; Teel, Joseph, MD; Srinivas, Sindhu K., MD, MSCE

doi: 10.1097/QMH.0000000000000191
Quality Improvement

Objective: The multifaceted nature of the transition of care from the triage unit to labor and delivery has historically led to confusion, delays, and errors in care. This study evaluated the effect of standardization of roles and communication on improving this transition.

Methods: A multidisciplinary team was assembled to define and standardize roles of team members. A huddle safety board was created as a visual aid to promote closed-loop communication during an admission bedside huddle. The primary metrics collected were duration of time from the admission decision in the triage unit to when the admission huddle was completed on labor and delivery, duration of time from the admission decision in the triage unit to initiation of the plan of care and documented completion of the admission huddle.

Results: There was a 66-minute reduction in time from the admission decision to the huddle completion between the preintervention and postintervention periods. There was a 93-minute reduction in the time from the admission decision to when the plan of care was initiated between the preintervention and post-intervention periods. The weekly huddle compliance rate improved from 48% to 84% by the postintervention period.

Conclusions: The implementation of standardized roles and processes facilitating closed-loop communication decreases delays in communication and initiation of care in pregnant women transferred from the triage unit to labor and delivery.

Departments of Obstetrics and Gynecology (Drs Lee and Srinivas) and Family Medicine (Dr Teel), University of Pennsylvania School of Medicine, Philadelphia; and Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland (Dr Colwill).

Correspondence: Daniel D. Lee, MD, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 3400 Spruce St, Fifth Floor Dulles Bldg, Philadelphia, PA 19104 (daniel.lee@uphs.upenn.edu).

This study was conducted at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

The authors report no conflict of interest.

© 2018Wolters Kluwer Health | Lippincott Williams & Wilkins