Implementing standardized assessment of preterm labor as a hospital quality improvement project

There is substantial evidence in the literature of wide variation in practices used to assess patients with preterm labor symptoms, more than 75% of whom will deliver at term. The Preterm Labor Assessment Toolkit (PLAT) is an evidence-based guide designed to standardize assessment and disposition of patients with preterm labor signs and symptoms. The ultimate goals of PLAT are: increased admissions among patients at risk for preterm delivery; decreased length of stay for patients not in preterm labor; increased transport of preterm labor patients when indicated; and decreased unnecessary tocolysis and steroid use. In 2012, a new edition of PLAT was released incorporating advances in research and best practices, and lessons learned from implementing the first edition of PLAT, which was developed through a partnership between March of Dimes California Chapter and Sutter Medical Center, Sacramento. From 2008-2011, March of Dimes evaluated PLAT's effectiveness in increasing appropriate patient assessment by clinicians. Evaluation methods included pre- and post-implementation chart audits to assess practice change. Chart audit data were coded for eight clinician decision points that define PLAT compliance. Data analysis from 16 hospitals demonstrated favorable impact of PLAT on clinicians' behaviors, including a statistically significant (p≤.05) increase in overall compliance with PLAT protocol (58% vs. 66%) and compliance with key decision points including use of sterile speculum exam (35% vs. 51%), assessment of cervical change (29% vs. 46%), and appropriate disposition decision based on cervical change assessment (29% vs. 46%). Final analyses for 25 hospitals will be reported in fall 2012.