262549 Implementing standardized assessment of preterm labor as a hospital quality improvement project

Monday, October 29, 2012 : 5:30 PM - 5:50 PM

Herman Hedriana, MD , Sacramento Maternal-Fetal Medicine Medical Group, Inc., Sacramento, CA
Mary Campbell Bliss, RN, MS, CNS , Sutter Medical Center, Sacramento, Sacramento, CA
Dana Edelman, MPH, CHES , March of Dimes, California Chapter, San Francisco, CA
Maura Georges, MPH, MSW , March of Dimes, California Chapter, San Francisco, CA
Leslie Kowalewski, BS , March of Dimes, California Chapter, San Francisco, CA
Victoria L. Lombardo, MSN, RN , March of Dimes. California Chapter, Glendale, CA
Peyton Mason-Marti, MPH , March of Dimes, California Chapter, San Francisco, CA
Gretchen Page, MPH, CNM , Loma Linda University Medical Center/Children's Hospital, Loma Linda, CA
Karalee Poschman, MPH , Texas Department of State Health Services, Austin, TX
Julie Solomon, PhD , J. Solomon Consulting, LLC, Mountain View, CA
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.

Learning Areas:
Administration, management, leadership
Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health
Public health or related nursing
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
List the key steps to implement and evaluate the Preterm Labor Asssessment Toolkit at a hospital. Describe how implementing standardized protocols and clinical algorithms for preterm labor assessment can improve consistency in clinicians’ decision making and increase appropriate disposition decisions for patients, while maintaining maternal/fetal safety. Identify opportunities to partner with hospitals on evidence-based quality improvement initiatives.

Keywords: Perinatal Outcomes, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary investigator for the California March of Dimes Preterm Labor Assessment Toolkit
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Hologic Inc Preterm Labor Assessment Speaker's bureau and teaching engagements

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.