Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care

Leila C. Kahwati, Asta V. Sorensen, Stephanie Teixeira-Poit, Sara Jacobs, Samantha A. Sommerness, Kristi K. Miller, Elizabeth Pleasants, Hanna Margaret Clare, Charles L. Hirt, Stanley E. Davis, Thomas Ivester, Donna Caldwell, Janet H. Muri, Kamila B. Mistry

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: The Safety Program for Perinatal Care (SPPC)seeks to improve safety on labor and delivery (L&D)units through three mutually reinforcing components: (1)fostering a culture of teamwork and communication, (2)applying safety science principles to care processes; and (3)in situ simulation. The objective of this study was to describe the SPPC implementation experience and evaluate the short-term impact on unit patient safety culture, processes, and adverse events. Methods: We supported SPPC implementation by L&D units with a program toolkit, trainings, and technical assistance. We evaluated the program using a pre-post, mixed-methods design. Implementing units reported uptake of program components, submitted hospital discharge data on maternal and neonatal adverse events, and participated in semi-structured interviews. We measured changes in safety and quality using the Modified Adverse Outcome Index (MAOI)and other perinatal care indicators. Results: Forty-three L&D units submitted data representing 97,740 deliveries over 10 months of follow-up. Twenty-six units implemented all three program components. L&D staff reported improvements in teamwork, communication, and unit safety culture that facilitated applying safety science principles to clinical care. The MAOI decreased from 5.03% to 4.65% (absolute change -0.38% [95% CI, -0.88% to 0.12%]). Statistically significant decreases in indicators for obstetric trauma without instruments and primary cesarean delivery were observed. A statistically significant increase in neonatal birth trauma was observed, but the overall rate of unexpected newborn complications was unchanged. Conclusions: The SPPC had a favorable impact on unit patient safety culture and processes, but short-term impact on maternal and neonatal adverse events was mixed.

Original languageEnglish (US)
Pages (from-to)231-240
Number of pages10
JournalJoint Commission Journal on Quality and Patient Safety
Issue number4
StatePublished - Apr 2019

Bibliographical note

Funding Information:
The implementation and evaluation of the program described in this manuscript was supported by RTI International under contract to the Agency for Healthcare Research and Quality (No. HHSA2902010000241 , Task Order 3).

Publisher Copyright:
© 2018 The Joint Commission


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