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Background: Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity in the United States, and timely treatment is imperative. Delay in treatment of PPH can lead to significant blood loss and increased morbidity and mortality. Supplies and medications essential for treating PPH are typically not located in close proximity to the hemorrhaging patient, leading to inefficiency and delay in timely response to hemorrhage. Methods: An in situ hemorrhage simulation was created dictating the collection of a prespecified list of supplies commonly used in response to PPH on labor and delivery (L&D). Baseline data were collected, then Lean Six Sigma tools were used to construct a process map, including recording times and cumulative distance traveled for collection of each item. The simulation was repeated after development, creation, and deployment of each intervention. For the first intervention, a PPH cart was created containing the supplies most used in response to PPH. Second, a PPH medication kit was created consisting of a refrigerated box containing all medications typically administered during a PPH. Results: The average time to collect a prespecified list of supplies and medications in response to a PPH scenario was 11 minutes 5 seconds (standard deviation [SD] = 3 minutes 33 seconds), with an average cumulative distance traveled of 4,092 feet. Following Intervention 1, the time decreased to 4 minutes 0 seconds, with 918 feet traveled (only one trial performed). Intervention 2 further reduced the average time and cumulative distance to 2 minutes 14 seconds (SD = 16 seconds) and 462 feet, respectively. This represents a 79.8% reduction in time and an 88.7% reduction in distance from baseline to postintervention. Conclusion: A PPH cart and medication kit can significantly reduce the amount of time and distance traveled to obtain materials necessary to treat hemorrhage, thus optimizing a team's ability to efficiently treat PPH.

BACKGROUND Intimate partner violence (IPV) is a significant public health issue. Healthcare providers (e.g., nurses, advanced practice nurses, physicians, social workers) have a unique opportunity to prevent and reduce IPV through screening and referral. The objective of this project was to determine the impact of education and a brief screening tool integrated into the electronic medical record (EMR) on readiness to screen for IPV. METHODS An intervention was implemented that included the EMR integration of a screening tool, creation of an automated resource telephone system and healthcare provider IPV screening and response education. Readiness for screening was evaluated pre- and postintervention using the Domestic Violence Health Care Provider Survey Scale (DVHCPSS), which is scored cumulatively and by each of six domains. An unpaired Student's t test was performed. RESULTS Mean age (31-40 years of age) and years of clinical practice (11-15 years) was the same for pre- (n = 96) and postintervention (n = 83) survey respondents. There was an overall significant increase in screening readiness (p = .003) with significant improvement in "professional role resistance/fear of offending the patient" (p

Background Several investigators have achieved remarkable success in transferring shoulder dystocia management skills mastered with simulation training to clinical practice. However, other investigators have not demonstrated similar benefits, raising questions about the comparative effectiveness of specific simulation schemes, instructional content, and additional quality assurance measures between successful and unsuccessful interventions. After our initial review revealed gaps in following shoulder dystocia management algorithms, documentation and timely follow-up of injured neonates, we developed and implemented five interventions, three educational and two systems-level, aimed at improving shoulder dystocia management. Objective To describe the clinical impact of a systematic program of quality improvement on outcomes of vaginal births complicated by shoulder dystocia. Setting An urban tertiary academic medical center that trains 36 obstetrics/gynecology residents (9 per year) and provides comprehensive obstetrical services for approximately 2,000 deliveries annually. Study Design We use SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) to (1) describe our core instructional content and simulation-based practice, emphasizing specific proscriptive and prescriptive recommendations and their evidence basis, and (2) to report an interrupted time series assessment of the clinical impact of our systematic quality improvement program targeting shoulder dystocia-associated brachial plexus injury. Results Compared with baseline (June 1993 to December 2004), the incidence of shoulder dystocia among vaginally delivered infants with birth weight ≥ 2,500 g at Johns Hopkins Hospital (January 2014 to December 2015) increased from 2.6 to 4.6% (X 2 = 29.8; df = 1; p Conclusion A systematic program of quality assurance with specific proscriptive and prescriptive instructional content and management recommendations is associated with improved recognition, management, and clinical outcomes of shoulder dystocia.

Interprofessional collaboration is critical to the provision of safe patient care and provider satisfaction. Collaboration is an active process that can help maximize positive patient outcomes. Three academic institutions implemented collaborative processes as part of their perinatal patient safety initiatives based on anecdotal experiences and safety culture surveys that demonstrated positive outcomes. Reliable tools and additional research are needed to measure the extent and impact of collaboration on patient outcomes in perinatal care.

The Johns Hopkins Oxytocin Protocol (JHOP) Survey was distributed to clinical labor and delivery staff to compare obstetrical providers' attitudes toward clinical protocols and the JHOP. Agreement by registered nurses (RNs), physicians in training (PIT), and attending physicians (APs) and certified nurse midwives (CNMs) was assessed with each of 4 attitudinal statements regarding whether clinical protocol and JHOP use result in better practice and are important to ensure patient safety. Odds of agreement with positive statements regarding clinical protocols did not differ significantly among groups. Odds of agreement with JHOP use resulting in better practice also did not differ significantly among provider groups. Odds of agreement with the JHOP being important to ensure patient safety were lower for the AP/CNM group compared with the RN group. Clinical protocol use is generally well received by obstetrical providers; however, differences exist in provider attitudes toward the use of an institutional oxytocin protocol.

Two groups of 20 mothers and their firstborn children (matched for age and sex) were investigated to determine whether sibling preparation for the birth of a newborn made a difference In the behavior of the children and in the mothers' perceptions of their own ability to cope with the children. One group of mothers and their children attended a sibling preparation class; the other group did not. Each group was pretested and posttested with the Parent‐Child Assessment Tool. A significant difference was found between the two groups.