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26. Healthcare system intervention for prevention of birth injuries – process evaluation of self-assessment, peer review, feedback and agreement for change

Author

Nyström Monica E, Westerlund Anna, Höög Elisabet, Millde-Luthander Charlotte, Högberg Ulf, and Grunewald Charlotta

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Patient safety is fundamental in high quality healthcare systems but despite an excellent record of perinatal care in Sweden some children still suffer from substandard care and unnecessary birth injuries. Sustainable patient safety improvements assume changes in key actors’ mental models, norms and culture as well as in the tools, design and organisation of work. Interventions positively affecting team mental models on safety issues are a first step to enhancing change. Our purpose was to study a national intervention programme for the prevention of birth injuries with the aim to elucidate how the main interventions of self-assessment, peer review, feedback and written agreement for change affected the teams and their mental model of patient safety, and thereby their readiness for change. Knowledge of relevant considerations before implementing this type of patient safety intervention series could thereby be increased. Methods Eighty participants in twenty-seven maternity units were interviewed after the first intervention sequence of the programme. A content analysis using a priori coding was performed in order to relate results to the anticipated outcomes of three basic interventions: self-assessment, peer review and written feedback, and agreement for change. Results The self-assessment procedure was valuable and served as a useful tool for elucidating strengths and weaknesses and identifying areas for improvement for a safer delivery in maternity units. The peer-review intervention was appreciated, despite it being of less value when considering the contribution to explicit outcome effects (i.e. new input to team mental models and new suggestions for actions). The feedback report and the mutual agreement on measures for improvements reached when signing the contract seemed exert positive pressures for change. Conclusions Our findings are in line with several studies stressing the importance of self-evaluation by encouraging a thorough review of objectives, practices and outcomes for the continuous improvement of an organisation. Even though effects of the peer review were limited, feedback from peers, or other change agents involved, and the support that a clear and well-structured action plan can provide are considered to be two important complements to future self-assessment procedures related to patient safety improvement.

Published
2012
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50. Uncertainty in nuchal translucency reference ranges at 11-14 weeks of gestation--comparison to Swedish centiles.

Author

KUBLICKAS, MARIUS, SALTVEDT, SISSEL, ALMSTRÖM, HARALD, GRUNEWALD, CHARLOTTA, CROSSLEY, JENNIFER, and Almström, Harald

Subjects
REGRESSION analysis, EQUATIONS, POPULATION, HOSPITALS, DOWN syndrome, COMPARATIVE studies, FETAL ultrasonic imaging, GESTATIONAL age, MATHEMATICS, RESEARCH methodology, MEDICAL cooperation, PREGNANCY complications, FIRST trimester of pregnancy, SECOND trimester of pregnancy, RESEARCH, STATISTICAL sampling, UNCERTAINTY, EVALUATION research, FETAL development
Abstract

Objective: To generate a regression equation for the nuchal translucency (NT) median for the Swedish population and compare this with other median values. Setting: Eight Swedish hospitals. Sample: The data set included 20 887 unaffected fetuses. Methods: Calculation and generation of an NT centile chart for the Swedish population. Results: The NT centiles for crown-rump length (CRL) from 45 to 84 mm were calculated and compared with the medians from Glasgow, from the Fetal Medicine Foundation (FMF, London, UK; FMF-original) and those published recently (FMF-new). The NT medians cease to increase at CRLs between 70 and 75 mm. The Swedish, FMF-new and Glasgow medians followed the same pattern, but the Glasgow NT median curve was systematically lower by around 20%. Swedish, FMF-new and Glasgow medians differed in shape from the FMF-original medians, which continuously increase throughout the whole range of CRLs. Conclusions: Our results demonstrate that there are substantial differences in the NT medians and centiles between countries. [ABSTRACT FROM AUTHOR]

Published
2011
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