With the recognition that medical care is often poorly provided, deficient, and excessively costly without benefit, there has been increasing scrutiny on the safety and quality of healthcare in the U.S. Two interrelated clinical areas that are at a nascent stage in the study of patient safety are maternal and neonatal care. As the U.S. continues to have higher maternal and neonatal mortality compared to other developed countries, we have an exciting opportunity to advance the science of safety in healthcare with a multidisciplinary approach including qualitative research methods, design thought, simulation, controlled trials, and implementation science. This project will focus on the safety of perinatal care, with a focus on labor and delivery, which is the most common reason for hospitalization in the U.S. The principles learned from our approach may also serve to study safety issues in other areas of the hospital. Therefore, this project has the potential to not only contribute to improving safety and quality for mothers and newborns, but also contribute to the general science of safety in healthcare. Our proposal will also have the potential to have an immediate impact on patient outcomes, as stages of the research will necessarily be carried out in patient care settings. In this proposed project, we will perform work that will: 1) establish a perinatal safety learning laboratory, 2) develop and test an optimal neonatal resuscitation data display, 3) develop and test an optimal maternal data display, 4) develop a process to recognize and prevent maternal clinical deterioration, and 5) develop the optimal physical design of a labor and delivery suite. Our safety learning laboratory will perform work on four interrelated projects: Project #1: An optimal interactive data display for neonatal resuscitation. Project #2: An optimal data display for labor and delivery. Project #3: Improving recognition of maternal clinical deterioration, and Project #4: Physical design of the optimal delivery suite. We will expand the knowledge base on patient safety for neonatal and maternal care by establishing a safety learning laboratory, bringing together obstetrics, neonatology, nursing, design specialists, engineers, and parent representatives, and using simulation methodology to develop, pilot, and test innovative designs in the four projects.

Public Health Relevance

While maternal admission for newborn birth is the most common reason for admission to a hospital, we are still a long ways from providing a safe delivery to all mothers. In fact, the U.S. infant mortality rate is three times high as other developed countries, and the maternal mortality ratio has increased in recent years. The knowledge gained from these studies will have the potential to have a significant impact on women and children's health, and form a foundation for further work in improving patient safety.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Center Core Grants (P30)
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Special Emphasis Panel (ZHS1-HSR-C (01))
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Bartman, Barbara
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Stanford University
Schools of Medicine
United States
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Lyndon, Audrey; Malana, Jennifer; Hedli, Laura C et al. (2018) Thematic Analysis of Women's Perspectives on the Meaning of Safety During Hospital-Based Birth. J Obstet Gynecol Neonatal Nurs 47:324-332
Lapcharoensap, Wannasiri; Lee, Henry C (2017) Tackling Quality Improvement in the Delivery Room. Clin Perinatol 44:663-681
Daniels, Kay; Hamilton, Colleen; Crowe, Susan et al. (2017) Opportunities to Foster Efficient Communication in Labor and Delivery Using Simulation. AJP Rep 7:e44-e48