Purpose for the program: Teamwork and effective communication have a profound impact on patient care; in the Delivery Room this means the best possible care for moms and babies.  With that goal in mind, our obstetrics team implemented a crew resource management (CRM) initiative.  While the principles of CRM are relatively new to the health care environment, literature does support the value of training healthcare teams in the principles of CRM.

Proposed change: The goal of the initiative was to improve patient care through improved communication between and among disciplines; situation monitoring throughout the continuum of care; mutual support and respect among care givers and effective team leadership.

Implementation, outcomes and evaluation: A mandatory CRM training program was presented to all staff members of Labor & Delivery (L&D); all attending anesthesiologists and obstetricians; nursing leadership; the Neonatology Director and Neonatal Nurse Practitioners.

Through team meetings and debriefings we identified areas in which patient care could be improved. For example, a team debriefing that followed a stat c-section precipitated several changes. Among these changes was a revision of the method used to track calls from physicians’ offices as well as the information recorded by nursing staff regarding location of covering physicians.  This translated into nursing staff being aware of the physician’s plan of care for each patient even before that patient’s arrival in L&D. It also triggered a collaborative effort between the Departments of Anesthesia and Nursing Education to provide in service to L&D nursing staff reviewing the RN’s role in assisting with general anesthesia. Such anecdotal episodes of success were supported by data.

Dr. Mann and her colleagues published standardized quality measures for obstetric patients and newborns. They identified ten adverse outcomes with associated severity scores. At our facility, medical records of mothers and newborns were analyzed to determine the incidence and significance of the ten adverse outcomes prior to and following CRM training.

Implications for nursing practice: Expecting health care professionals to work as a team has enhanced performance and improved outcomes for mother and baby. Improved communication with the nurses on the maternity unit has smoothed the transition of patient care between departments. Since the completion of training and initiation of team meetings, we realized a significant improvement in both the incidence and severity of adverse outcomes following the CRM training as well as a significant improvement in employee satisfaction.

Keywords: teamwork, safety, communication