In recent years, maternal health in the United States has been declining. According to the Centers for Disease Control and Prevention, the maternal death rate in the US has risen steadily over the past decade, with the majority of these deaths being preventable. Combating this trend through quality improvement in obstetrics care has become a central focus. By implementing standardized care based on best practices and providing effective training, healthcare organizations have the power to significantly improve outcomes in obstetrics care and ensure patient safety.
The Impact of Quality Improvement
Quality improvement initiatives play a crucial role in achieving better patient outcomes in obstetrics care. Initiatives such as perinatal reviews and maternal quality collaboratives bring together healthcare providers from across the system to discuss and learn from cases of adverse outcomes, leading to performance improvement. Most healthcare organizations acquire international certifications, like the Joint Commission International Accreditation (JCIA), and accreditation of hospitals that recognize excellence in perinatal medicine. These initiatives ensure adherence to prescribed protocols and guidelines.
An example of standard care protocol success is a study on the California Maternal Quality Care Collaborative (CMQCC) Toolkit that provides approaches and strategies for providing care to women with maternal hemorrhage, hypertension, and severe sepsis. The implementation of this Toolkit averted 913 cases of severe maternal morbidity (SMM), 28 emergency hysterectomies, and one maternal death. It also resulted in $9 million saved.
The success of the Toolkit lies in its standardized, evidence-based protocols that greatly improve clinical management. “Quality improvement efforts in maternity care not only save lives; they can save costs,” said study co-author Elliott Main, MD, clinical professor of obstetrics and gynecology at Stanford Medicine and medical director of the California Maternal Quality Care Collaborative. Dollars saved can be reinvested into staff training to further improve maternal care and outcomes. For so many health systems that follow Joint Commission standards but still fall short of their patient safety goals, effective training is the link between having standards in place and ensuring standardized action and care. But implementing successful quality improvement training at scale can be challenging. Here are some critical points to consider.
Steps to successful quality improvement in obstetrics care
1. Utilizing the power of data analytics and technology
Obstetrics care also benefits significantly from data analytics and technology as the application of business intelligence systems can help monitor and analyze large volumes of data to identify likely adverse events. Predictive analytics can help detect early warning signs and intervene before an adverse event occurs. The use of electronic health records makes data recording, graphing, and analyzing easy, which can help identify deviations from standard care practices with ease. Technology also empowers patients to participate in their care plan by accessing data at any time and communicating with healthcare providers.
2. Reinforcing established standard practices with effective training
Establishing standard care processes, such as the Joint Commission’s, is just the beginning. It is equally important to ensure that these practices are understood, followed, and regularly updated. But simply offering training is not enough — clinicians need fast and effective training that works. Otherwise, the standard best practices health systems work so hard to identify and develop are useless. Continuous improvement of skills and knowledge, rigorous training exercises, and assessment can significantly enhance performance. By delivering safe and effective treatment during pregnancy, childbirth, and the postpartum period, healthcare providers can make a tangible difference in patient outcomes.
3. Prioritizing patient equity
Centers for Disease Control and Prevention (CDC) data reveals that American Indian/Alaska Native and Black women are 2 to 3 times as likely to die from a pregnancy-related cause than white women, among other figures that indicate racial disparities in obstetrics care and patient outcomes. Although this data created much-needed awareness around this issue, simply recognizing the problem does not translate to improved outcomes. Quality and improvement teams need clear action plans around this issue to be reinforced with effective training. Obstetrics departments that successfully tackle this gap in care will set themselves apart from those who do not make it a priority.
4. Emphasizing patient empowerment and informed consent
Patient empowerment is critical to enhancing obstetrics care outcomes and maximizing quality improvement efforts. Research indicates that patient education efforts have been proven to lead to more positive outcomes. Care goes beyond applying procedures or making a diagnosis. Patients and their families need to embody trust and collaborate in partnership with healthcare providers, enabling better decision making, and developing the understanding that supports shared goals and transparent communication. This way, patients are better empowered to make informed decisions about their care.
The declining maternal health statistics in the United States are alarming, and it is up to us as healthcare providers to adopt data-driven standardized care, reinforced by effective training, to enhance patient outcomes in obstetrics care. Implementing standard care practices, revisiting continuous learning and training, utilizing data analytics and technology, and empowering patients are just some of the critical elements that can be expanded upon to set the system on a positive trajectory. It is vital that those decision-makers who oversee care delivery invest in these strategies and make addressing the decline in maternal health statistics a priority. Ultimately, this will improve obstetrics care, increase maternal and infant safety, and empower women in their healthcare.
