A small community hospital located in the Midwest identified several opportunities to improve patient outcomes in the obstetric population. Being a small community Level I facility, delivering approximately 400 babies per year, the hospital had limited resources.

Proposed change:

One advantage to being part of a health care system is the ability to utilize additional resources.  The level I facility worked in collaboration with the health care system’s Level III maternity center to standardize nursing practice and improve patient outcomes.  This collaborative effort brought the experience and resources of the program at the Level III maternity center into the Level I community hospital.

Implementation, outcomes and evaluation:

The first step in merging these programs was to standardize nursing education and validate nurse competency. Policies and procedures were reviewed to assure compliance with those used at the Level III facility and also with maternity licensure requirements.  Remote monitoring was put in place to enhance peer review and peer coaching opportunities. Chain of command policies were reviewed  Nursing staff from the Level III facility were assigned to be present during the night shift at the Level I facility with the purpose of mentoring and teaching. Staff nurses at the Level I facility rotate on a quarterly basis to the Level III facility in order to gain exposure to a variety of patient conditions and treatments. An OB multidisciplinary committee consisting of nurses and physicians from both facilities meets monthly. All high risk patients seen by physicians or the clinic at the Level I facility are reviewed monthly by the Level III Maternal Fetal Medicine Physicians.

Nurses successfully validated their nursing skills and critical thinking ability. There is an increase in the number of nurses holding certification and memberships in professional nursing organizations.  Assessment of the high risk patient improved and referrals to the Level III facility increased.  Physician/nurse communication improved.  There is enhanced utilization of medical peer review.  Communication with other disciplines improved.  Press Ganey scores are higher. There have been no sentinel events or serious safety events since the collaboration was initiated.   

Implications for nursing practice:

Utilization of Level III maternity center resources can help small community hospitals standardize practice thereby improving patient safety and patient outcomes. Collaborative efforts between hospitals in a system can provide valuable learning opportunities for all involved.

Keywords: collaboration, standardization, outcomes