An Unusual Journey for Patient Safety: The Partnership between a Level I Community Hospital and a Level III Birthing Center


Poster Presentation

Purpose for the Program

A small community hospital located in the Midwest identified several opportunities to improve patient outcomes in the obstetric population. Because it was a small community level I facility that delivered approximately 400 infants per year, the hospital had limited resources.

Proposed Change

One advantage to being part of a health care system is the ability to utilize additional resources. The level I facility worked in collaboration with the health care system's level III maternity center to standardize nursing practice and improve patient outcomes. This collaborative effort brought the experience and resources of the level III maternity center's program into the level I community hospital.

Implementation, Outcomes, and Evaluation

The first step in merging these programs was to standardize nursing education and validate nurse competency. Policies and procedures were reviewed to ensure adherence to those used at the level III facility and also with maternity licensure requirements. Remote monitoring was put in place to enhance peer review and peer coaching opportunities. Chain of command policies were reviewed. Nursing staff from the level III facility were assigned to be present during the night shift at the level I facility with the purpose of mentoring and teaching.

Staff nurses at the level I facility rotate on a quarterly basis to the level III facility to gain exposure to a variety of patient conditions and treatments. An obstetric multidisciplinary committee consisting of nurses and physicians from both facilities meets monthly. All high-risk patients seen by physicians or at the clinic within the level I facility are reviewed monthly by the level III maternal–fetal medicine physicians. Nurses successfully validated their nursing skills and critical thinking ability. There is an increase in the number of nurses holding certification and memberships in professional nursing organizations. The assessment of the high-risk patient improved and referrals to the level III facility increased. Physician–nurse communication and the communication with other disciplines improved. There is enhanced utilization of medical peer review and the Press Ganey scores are higher. There have been no sentinel events or serious safety events since the collaboration was initiated.

Implications for Nursing Practice

Utilization of level III maternity center resources can help small community hospitals standardize practice and, thereby, improve patient safety and outcomes. Collaborative efforts between hospitals in a system can provide valuable learning opportunities for all involved.