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Background: Multidisciplinary rounds (MDRs), a model of care in which multiple members of the care team, representing different disciplines, come together to discuss the care of a patient in real-time. MDRs are a valuable tool for clinical teams to improve patient length of stay (LOS), reduce healthcare-associated infections, and increase care coordination. HCA Healthcare's data science and performance improvement teams created a data visualization tool called Next-gen Analytics for Treatment and Efficiency (NATE) Tempo to support care teams in managing rounds and barriers. Methods: A pilot implementation of MDRs using the NATE Tempo tool was initiated in 10 hospitals, accompanied by a survey for Chief Medical Officers (CMOs) of each of the participating hospitals. Results: Implementation of MDRs using the NATE Tempo tool was associated with an average reduction in LOS ratio from 135% to 114% across the 10 hospitals. CMO survey feedback identified areas of improvement related to MDR participation, and incorporation of NATE Tempo. CMO leadership within each facility and the use of the interactive dashboard facilitated the identification of high performers and areas of opportunity for improvement. Conclusion: CMO engagement can help physicians take steps to decrease variation in practice, leading to compliance with best practice guidelines and decreasing the overall LOS in hospitals. The MDR process can support these efforts. Empowering CMOs through the use of the NATE Tempo tool improved engagement. Through the tool, the CMO promotes coordination of patient care throughout the hospital experience and during the post-discharge phase.
RESUMO
BACKGROUND: Oxytocin protocols are employed to induce uterine contractions and progressive cervical changes, but they are associated with adverse maternal and neonatal outcomes. The aim of this study was to determine whether compliance with a checklist-based protocol for oxytocin administration was associated with changes in neonatal and maternal outcomes. METHODS: A retrospective cohort study of 86,786 pregnant women undergoing term (> 37 weeks) induction of labor between January 2015 and December 2017 was performed. Systemwide training in the use of an oxytocin administration protocol was provided to obstetricians and nurses. Pre-use and in-use oxytocin checklists were incorporated into each unit's policies and procedures. Subsequently, charts were reviewed and individually audited by an obstetric nurse who scored each record based on the documentation of variables in an oxytocin administration protocol and ranked adherence as complete or absent. Primary outcomes were postpartum hemorrhage, neonatal ICU (NICU) admission, and delivery by cesarean section. Bivariate analyses (t-tests) were performed on adherent and nonadherent groups for comparison of selected demographic variables and the primary outcome variables. Logistic regression was completed on the primary outcome variable with eight covariates. RESULTS: Among patients with complete adherence to the oxytocin administration protocol, the rate of cesarean section in the unadjusted analysis was 16.20%, compared to 18.54% for those with incomplete adherence; the rates of postpartum hemorrhage were 2.64% vs. 3.14%, respectively, and the rates of NICU admission were 3.03% vs. 3.86%, respectively. In the multivariable logistic regression, complete protocol adherence was associated with significantly lower odds of postpartum hemorrhage (adjusted odds ratio [OR] 0.85, 95% confidence interval [CI] 0.76-0.94) but higher odds of Cesarean section (adjusted OR 1.07, 95% CI 1.01-1.13); the adjusted OR for NICU admission was 0.90, which did not reach statistical significance (95% CI 0.81-1.00). Among the covariates, nulliparity and elective induction were the strongest predictors of the primary outcomes of cesarean section, postpartum hemorrhage, and NICU admission. CONCLUSION: Adherence to the oxytocin administration protocol was associated with a decrease in postpartum hemorrhage but an increased risk of delivery by cesarean section.