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Alfred MC, Wilson D, DeForest E, Lawton S, Gore A, Howard JT, Morton C, Hebbar L, Goodier C. Investigating Racial and Ethnic Disparities in Maternal Care at the System Level Using Patient Safety Incident Reports. Jt Comm J Qual Patient Saf 2024; 50:6-15. [PMID: 37481433 DOI: 10.1016/j.jcjq.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Maternal mortality in the United States is high, and women and birthing people of color experience higher rates of mortality and severe maternal morbidity (SMM). More than half of maternal deaths and cases of SMM are considered preventable. The research presented here investigated systems issues contributing to adverse outcomes and racial/ethnic disparities in maternal care using patient safety incident reports. METHODS The authors reviewed incidents reported in the labor and delivery unit (L&D) and the antepartum and postpartum unit (A&P) of a large academic hospital in 2019 and 2020. Deliveries associated with a reported incident were described by race/ethnicity, age group, method of delivery, and several other process variables. Differences across racial/ethnic group were statistically evaluated. RESULTS Almost two thirds (64.8%) of the 528 reports analyzed were reported in L&D, and 35.2% were reported in A&P. Non-Hispanic white (NHW) patients accounted for 43.9% of reported incidents, non-Hispanic Black (NHB) patients accounted for 43.2%, Hispanic patients accounted for 8.9%, and patients categorized as "other" accounted for 4.0%. NHB patients were disproportionally represented in the incident reports, as they accounted for only 36.5% of the underlying birthing population. The odds ratio (OR) demonstrated a higher risk of a reported adverse incident for NHB patients; however, adjustment for cesarean section attenuated the association (OR 1.25, 95% confidence interval 1.01-1.54). CONCLUSION Greater integration of patient safety and health equity efforts in hospitals are needed to promptly identify and alleviate racial and ethnic disparities in maternal health outcomes. Although additional systems analysis is necessary, the authors offer recommendations to support safer, more equitable maternal care.
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Gaulton J, Crowe B, Sherman J. How Design Thinking and Quality Improvement Can Be Integrated into a "Human-Centered Quality Improvement" Approach to Solve Problems in Perinatology. Clin Perinatol 2023; 50:435-448. [PMID: 37201990 DOI: 10.1016/j.clp.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Both quality improvement (QI) and design thinking (DT) methodologies have their unique strengths and weaknesses. Although QI sees problems through a process-centered lens, DT leverages a human-centered approach to understand how people think, behave, and act when encountering a problem. By integrating these 2 frameworks, clinicians have a unique opportunity to rethink how to solve problems in health care by elevating the human experience and putting empathy back at the center of medicine.
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Affiliation(s)
- Jessica Gaulton
- Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RO-320, Boston, MA 02215, USA.
| | - Byron Crowe
- Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Jules Sherman
- Biodesign Program, Children's National Hospital, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
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Sands G, Evans K, Spiby H, Eldridge J, Pallotti P, Evans C. Birth environments for women with complex pregnancies: A mixed-methods systematic review. Women Birth 2023; 36:39-46. [PMID: 35431173 DOI: 10.1016/j.wombi.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Birth environments can help support women through labour and birth. Home-like rooms which encourage active birthing are embraced in midwifery-led settings. However, this is often not reflected in obstetric settings for women with more complex pregnancies. AIM To investigate the impact of the birth environment for women with complex pregnancies. METHODS This was a mixed-methods systematic review, incorporating qualitative and quantitative research. A literature search was implemented across three databases (Medline, CINAHL, Embase) from the year 2000 to June 2021. Studies were eligible if they were based in an Organisation for Economic Cooperation and Development country and reported on birth environments for women with complex pregnancies. Papers were screened and quality appraised by two researchers independently. FINDINGS 30,345 records were returned, with 15 articles meeting inclusion criteria. Studies were based in Australia, the UK, and the USA. Participants included women and health professionals. Five main themes arose: Quality of care and experience; Supportive spaces for women; Supportive spaces for midwives; Control of the space; Design issues. DISCUSSION Women and midwives found the birth environment important in supporting, or failing to support, a positive birth experience. Obstetric environments are complex spaces requiring balance between space for women to mobilise and access birthing aids, with the need for medical teams to have easy access to the woman and equipment in emergencies. CONCLUSION Further research is needed investigating different users' needs from the environment and how safety features can be balanced with comfort to provide high-quality care and positive experiences for women.
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Affiliation(s)
- Gina Sands
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK.
| | - Kerry Evans
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Helen Spiby
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Jeanette Eldridge
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Phoebe Pallotti
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Catrin Evans
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
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Sotto KT, Hedli LC, Sie L, Padua K, Yamada N, Lee H, Halamek L, Daniels K, Nathan-Roberts D, Austin NS. Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery. PLoS One 2021; 16:e0252888. [PMID: 34111177 PMCID: PMC8191948 DOI: 10.1371/journal.pone.0252888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/25/2021] [Indexed: 11/29/2022] Open
Abstract
Cesarean delivery is the most common surgery performed in the United States, accounting for approximately 32% of all births. Emergency Cesarean deliveries are performed in the event of critical maternal or fetal distress and require effective collaboration and coordination of care by a multidisciplinary team with a high level of technical expertise. It is not well understood how the physical environment of the operating room (OR) impacts performance and how specialties work together in the space.
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Affiliation(s)
- Kenji T. Sotto
- San José State University, San Jose, California, United States of America
- * E-mail: (KTS); (DNR)
| | - Laura C. Hedli
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Lillian Sie
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Kimber Padua
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Nicole Yamada
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Henry Lee
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Louis Halamek
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Pediatrics, Stanford University, Stanford, California, United States of America
| | - Kay Daniels
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California, United States of America
| | - Dan Nathan-Roberts
- San José State University, San Jose, California, United States of America
- * E-mail: (KTS); (DNR)
| | - Naola S. Austin
- The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, United States of America
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