Kaiser Permanente Facilities Use TeamSTEPPS To Improve Obstetrics and Other Patient Care

As a result of implementing AHRQ's TeamSTEPPS® to improve teamwork and communication, Kaiser Permanente in Northern California has reduced the dosage of labor-inducing drugs by approximately 15 percent, without increasing C-section rates, from 2015 to 2017. Kaiser trained its staff at 16 medical centers and a skilled nursing facility across the State. As a result, perinatal teams have successfully used TeamSTEPPS strategies to standardize and reduce variation in dosing of labor-inducing drugs.

TeamSTEPPS is an evidence-based, customizable program aimed at optimizing performance among teams of healthcare professionals, enabling them to respond quickly and effectively to whatever situations arise. It was developed by AHRQ in collaboration with the Department of Defense and first launched in 2006.

Initially, Kaiser's main focus was to train teams for three new hospitals prior to their opening and to "build TeamSTEPPS expertise at the regional risk management and patient safety department in Oakland to support the new teams," explained Celia Ryan, M.S.H.A., R.N., executive director of risk and patient safety. Officials were so pleased with the results that they expanded TeamSTEPPS implementation to training teams in emergency departments, operating rooms, and inpatient units in all of Kaiser's Northern California hospitals.

In total, 45 Kaiser teams have completed TeamSTEPPS "train the trainer" programs since 2014. Staff have been trained across a wide variety of units, including emergency departments, intensive care, coronary care, cardiac catheterization laboratories, neonatal intensive care, medical/surgery/telemetry, interventional radiology, environmental services, perioperative (including pre-operative, operating room, and post-anesthesia care), perinatal (labor and delivery, nursery, and mother/baby), and skilled nursing units.

The perinatal teams at Kaiser commonly use the following TeamSTEPPS strategies—

• Huddle—An ad hoc meeting/planning session used to reinforce plans that are already in place. This allows for on-the-spot assessment and reassessment. Huddles are held daily with multidisciplinary teams comprised of obstetricians, certified nurse midwives, residents, registered nurses, anesthesiologists, and pediatric specialists who review the patient’s status, any concerns about her condition or treatment, and fetal monitoring.
• Debrief—An after-action review and/or information-sharing session intended to improve team performance and effectiveness. Debriefs help identify and resolve concerns and address timely acquisition of additional staff assistance when needed.
• SBAR—An acronym that stands for Situation, Background, Assessment, and Recommendation. This technique facilitates prompt and effective communications among staff. A "baby SBAR" is used to ensure situational awareness between the obstetrician and neonatal teams to establish the delivery approach and anticipate potential resuscitation needs.

"During times of high volume, huddles have improved workflows and situational awareness," said Paul Preston, M.D., staff anesthesiologist and safety educator for The Permanente Medical Group. "Debriefs have also been critically useful—specifically post-delivery and for real-time learning—and have contributed to improvements in the obstetrics hemorrhage team response and C-section decision-to-incision time," he noted.