Background:  In healthcare, just as in aviation, communication failures have been shown to be at the root cause of 70% of adverse events.  Data from our own institution confirmed this finding.  Handoffs are known to be especially vulnerable times.  Communication and teamwork training, known as Crew Resource Management, has been shown to substantially improve the safety of commercial aviation.  The principles of communication and teamwork training are beginning to be utilized to improve communication and handoffs in healthcare.  Salem Hospital has been measuring patient harm using the Institute for Healthcare Improvement’s Perinatal Trigger Tool sampling since November 2006.

Project:  An outside vendor was contracted to provide a four hour training in communication and teamwork to each member of the nursing staff in labor and delivery, mother-baby and the neonatal intensive care units.  It was also attended by all of the providers with obstetrical privileges as well as other staff members such as surgical techs, unit clerks and housekeeping.  Following the four hour training, a multidisciplinary team with representation from all three units met to identify areas of potential communication breakdowns.  Safety tools such as checklists and standardized handoffs were then designed to address these specific areas of difficulty.  The tools developed include a multidisciplinary “huddle” at the beginning of each shift attended by the L&D nursing staff, the OB hospitalist, OB anesthesiologist and representation from the mother-baby unit and NICU, standardized handoffs for the nursing staff and OB hospitalists and a standardized communication to the neonatal resuscitation team.  Additionally, peri-operative tools include a pre-operative checklist and a standardized pre-procedural time-out.

Results:  The safety tools were implemented on the units over a period of six months achieving >95% compliance with the use of the tools.  Subsequently, the average rate of harm as determined by perinatal trigger tools sampling has fallen from an average of 20% to less than 5%.