By Douglas H Stutz, Naval Hospital Bremerton Public Affairs
Naval Hospital Bremerton’s resourceful efforts in improving patient safety were recognized May 2 in the 2013 DoD Quality and Patient Safety Awards by the Office of the Assistant Secretary of Defense (for) Health Affairs.
NHB’s submission “Breaking the Cycle of Unnecessary Repeat Cesarean Sections Utilizing an Innovative Patient Centered Approach to Counseling” was selected as one of the two recipients who received Honorable Mention in the 2013 Quality and Patient Safety Awards.
“On behalf of the DoD Patient Safety program, I’d like to acknowledge your outstanding contribution to the 2013 DoD Quality and Patient Safety Awards. Your patient safety initiative has advanced safer patient care and helped create a culture of safety. By doing so, your facility has shown immense dedication to your community of patients and care givers,” wrote Army Maj. Gen. Richard W. Thomas, Director of Healthcare Operation, in a letter to Capt. Christopher Quarles, NHB commanding officer.
The facility submission was set in motion by Cmdr. Susan Toyama, NHB Quality Management department head, who explained that the initiative was developed in 2010 through the command’s Perinatal Advisory Board, lead by Dr. Christopher Tatro, staff physician in OB/GYN clinic.
“It was done in an effort to increase quality and patient safety by implementing a standardized approach to delivery planning in all pregnant patients with a prior cesarean delivery. Both repeat c/sections and trial of labor after cesarean (TOLAC) are associated with specific risks. But patients with a Successful TOLAC leading to a Vaginal Birth after Cesarean (VBAC) do confer less morbidity in the short and long term. It is critical then that patients in this category are counseled well and selected carefully,” said Toyama.
Toyama noted that the normal practice at many hospitals is to talk about the plan during individual appointment times as the pregnancy progresses, which can be a ‘hit and miss’ scenario in regards to sharing information and insight from provider to the patient.
“So some patients will receive good counseling, and others are left with questions but never have opportunity to ask. Some who proceed with a TOLACs are not necessarily the best candidates,” Toyama said.
The solution? A 60-minute monthly group appointment class – held in the OB clinic/classroom setting – was developed at NHB. Standardized counseling material is presented allowing for questions and answers from patients and their families. The same provider taught the class each time which made the sessions very consistent in information sharing.
“The group setting and long appointment time seemed to empower patients to taken an active role in their care and allow those patients time to review options and make informed decisions. Most who are not good candidates to start with will “opt” themselves out after hearing all the information,” Toyama stated.
Toyama attests that the success rate of those who attend the class and attempt a TOLAC has been 96-100 percent, and The VBAC rate has increased and c/section rate has decreased at NHB, well above Navy, Department of Defense and national benchmark rate levels.
“Even though Dr. Tatro developed and taught the classes up until this past year, it took a team effort to make it happen. Family Practice and OB providers had to send their patients to the class and the crew in the clinic had to set up and check patients in for the class. If patients had questions after the class staff had to be available. Everyone involved made it happen,” said Toyama.
The submitted abstract of the initiative has been posted on the DoD Patient Safety Learning Center – http://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Quality-And-Safety-of-Healthcare/Patient-Safety/Patient-Safety-Products-And-Services/Patient-Safety-Learning-Center – to share with other patient safety champions in the military health system.