Published online November 1, 2006
PEDIATRICS Vol. 118 Supplement November 2006, pp. S147-S152 (doi:10.1542/peds.2006-0913L)

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ARTICLE

Evaluation and Development of Potentially Better Practices for Perinatal and Neonatal Communication and Collaboration

Judy Ohlinger, RNC, MSN^a, Anand Kantak, MD^b, Justin P. Lavin, Jr, MD^c, Ona Fofah, MD^d, Erik Hagen, MD^e, Gautham Suresh, MD^f, Louis P. Halamek, MD^g and Janice A. Schriefer, DrPH^h

^a Neonatal Intensive Care Unit
^b Departments of Neonatology
^c Perinatology, Akron Children's Hospital and Akron General Medical Center and Summa Health System, Akron, Ohio
^d Department of Neonatology, Rockford Memorial Hospital, Rockford, Illinois
^e Department of Neonatology, Children's Hospitals and Clinics and United Hospital Birth Center, St Paul, Minnesota
^f Department of Neonatology, Medical University of South Carolina, Charleston, South Carolina
^g Center for Advanced Pediatric Education, Stanford University, Stanford, California
^h Vermont Oxford Network, Burlington, Vermont

Objective. The obstetric and neonatal exploratory focus group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative 2002 set out to improve collaboration, communication, and coordination between maternal and neonatal caregivers in 3 areas: the pregnancy at 22 to 26 weeks, measurement of maternal outcomes that are linked with neonatal outcomes, and team performance during high-risk delivery. Antepartum and intrapartum maternal attributes and interventions also were considered important measurements to identify practice variations and their relationship to neonatal outcomes for ongoing obstetric and neonatal collaboration.

Methods. Potentially better practices were developed on the basis of evidence in the literature, expert opinion, and internal analysis at the participating perinatal centers. The potentially better practices include development of local guidelines at each center for the care and counseling of pregnant women who are at risk for delivering at the margin of viability; communication strategies for obstetric and neonatology providers relating to high-risk pregnancy treatment plans; team communication and performance at high-risk deliveries; design of organizational structures and processes that facilitate obstetric and neonatal collaboration; and development of perinatal data to evaluate effects of perinatal practices on maternal, fetal, and neonatal outcomes.

Results. As a result of the project, participating centers developed local guidelines for pregnancies between 22 and 26 weeks, created a cross-center maternal database that currently is being linked to neonatal outcomes, and completed a pilot study on video simulation of neonatal–perinatal team communication.

Conclusions. Increased understanding of practice variation in the management of care for infants who are at the margins of viability, locally developed guidelines, and a focus on improved team communication during delivery can be accomplished with a multicenter collaborative approach.

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Key Words: perinatal • collaborative quality improvement • crew resource management • video simulation • team performance

Abbreviations: PBP—potentially better practice

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Accepted Jul 18, 2006.

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