The Value of a Cross-Disciplinary Approach to Human and System Performance Research in Obstetrics and Neonatology: AHRQ's Patient Safety Learning Laboratory.

Abstract

Objective: In creating an Agency for Healthcare Research and Quality (AHRQ) Patient Safety Learning Laboratory (PSLL), our objective has been to establish a multidisciplinary research environment focused on the safe care of pregnant women and newborns. This manuscript describes work performed under grants P30 HS023506 (obstetric focus) and R18 HS029123 (neonatal focus).

Methods: We follow AHRQ's 5-step approach to systems engineering in health care: problem analysis, design, development, implementation, and evaluation. Within this 5-step approach, methods used include interviews, focus groups, direct observation, teamwork scales, flow disruption analysis, the Systems Engineering Initiative for Patient Safety model, design thinking, and simulation-based testing of processes and prototypes.

Results: Grant P30 HS023506 is completed. The physical characteristics of 10 labor and delivery units were examined, finding significant heterogeneity in size, design, and organization. Task analysis revealed multiple obstacles to optimal team performance. We designed and tested a delayed cord clamping cart to address inherent ergonomic challenges. Finally, we identified common lapses in verbal communication during obstetric emergencies. Grant R18 HS029123 is ongoing. Eighteen Need Statements serve as the basis for exploratory work in mitigating threats to neonates during resuscitation, including a task analysis to determine points of intervention. We are developing (a) novel resuscitation platforms, (b) improved methods of equipment/supply organization, (c) new means of acquiring, displaying, and processing multiple data streams, and (d) innovative techniques and devices for neonatal intubation.

Conclusions: The approach to systems engineering in health care supported by AHRQ's PSLL funding mechanism fosters critical thinking about safety issues by facilitating the integration of investigators with diverse, complementary expertise. By encouraging such collaboration, AHRQ's 5-step process enables important questions to be answered. The PSLL mechanism is a valuable resource for the patient safety community.