Development of a Quality Indicator to Measure Urgent Requests to the Bedside.

OBJECTIVE: To develop a quality indicator describing the response time to an urgent request for a physician to the bedside of a pregnant or postpartum woman and to identify opportunities for improvement in care timeliness for women with worsening serious clinical conditions. DESIGN: Evidence-based quality improvement project using the Iowa Model-Revised framework to develop a maternal care quality indicator. SETTING: Labor and delivery, antepartum, and mother/baby units in a large urban safety-net hospital preparing for a state level of maternal care designation survey. PARTICIPANTS: All nurses and physicians caring for hospitalized pregnant and postpartum women participated in implementation. INTERVENTION/MEASUREMENTS: Physician response time was measured as the elapsed time from a nurse's urgent request for a physician and the presence of a physician at the bedside of a woman in one of the identified units, as recorded in the electronic health record. RESULTS: Physician response time to an urgent request to the bedside was documented 179 times during the first 3 months after implementation. Physician presence at the bedside within 30 minutes of a request was recorded in more than 99% of these events. CONCLUSION: Physicians' responses to early warning signs within our facility were timely and within the parameters established by the Texas state-mandated criteria for a Level IV maternal care hospital. Response time as documented in the electronic health record provides an important quality indicator of maternal care in the inpatient setting.

Patient Perspectives on Audio-Only Virtual Prenatal Visits Amidst the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic.

OBJECTIVE: To evaluate patient satisfaction after integration of audio-only virtual visits into a pre-existing prenatal care schedule within a large, county-based system during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHODS: We implemented audio-only prenatal virtual visits in response to the SARS-CoV-2 pandemic within a large, county-based prenatal care system serving predominantly women with low socioeconomic status and limited resources. Using a four-question telephone survey, we surveyed a cross-section of patients who had opted to participate in virtual visits to assess their level of satisfaction surrounding audio-only visits. In addition, average clinic wait times and attendance rates by visit type were examined. RESULTS: From March 17 to May 31, 2020, more than 4,000 audio-only virtual prenatal visits were completed in our system. After implementation, the percentage of visits conducted through the virtual platform gradually rose, with nearly 25% of weekly prenatal visits being performed through the virtual platform by the month of May. Clinic wait times trended downward after implementation of virtual visits (P<.001). On average, 88% of virtual prenatal visits were completed as scheduled, whereas only 82% of in-person visits were attended (P<.001). Hospital administration attempted to contact 431 patients who had participated in at least one virtual visit to assess patient satisfaction; 283 patients were reached and agreed to participate (65%). Ninety-nine percent of respondents reported that their needs were met during their audio-only virtual visits. The majority of patients preferred a combination of in-person and virtual visits for prenatal care, and patients reported many benefits with virtual visits. CONCLUSION: Audio-only virtual prenatal visits-as a complement to in-person prenatal visits-have specific and distinct advantages compared with video-enabled telehealth in a vulnerable population of women and offer a viable option to increase access to care.