Enhancing care escalation in hospital settings during childbirth

Effective escalation of care in the hospital setting is vital to prevent poor patient outcomes. In response to the Victorian Managed Insurance Authority's (VMIA) recognition of adverse outcomes during childbirth and the potential impact of ineffective escalation, RANZCOG’s Fetal Surveillance Education Program expanded their online educational resources (OFSEP) to include education related to escalation of care.

RANZCOG engaged BehaviourWorks Australia to develop an interactive, evidence-based module to help clinicians navigate some of the communication challenges and behavioural principles impacting escalation of care.  

The stakes couldn’t be higher

For clinicians, providing effective maternity care comes with real and high-stakes challenges; the welfare of mothers and babies. While care escalation mostly goes to plan—resulting in early and lower level intervention—delays in recognition or response to deterioration can result in unfavourable outcomes for women, and their families. It can also adversely impact the clinicians caring for them. It is not only about having the clinical skills necessary to recognise deterioration; it is being able to actively listen and collaborate, and navigating factors that can impact decision-making and behaviour during escalation of care.

The challenge:
To help clinicians recognise and navigate some of the challenges associated with effective care escalation during labour and delivery
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), funded by the Victorian Managed Insurance Authority (VMIA).

What did we do?

The project consisted of anumber of steps:

  1. We conducted a rapid literature review and practice review (interviews with clinicians) to understand barriers and facilitators to effective care escalation during labour and delivery;
  2. We mapped these onto existing frameworks to help identify and prioritise which barriers could be addressed via an online education module;
  3. We designed an interactive online education module, including scenario videos, testimonial videos, online content and interactive activities, and;
  4. We trialled the intervention via RANZCOG's OFSEP.

What did we find?

The online education module was designed to be engaging and interactive. It significantly improved clinicians' understanding and confidence around communication and behavioural factors in care escalation.  

Most participating clinicians rated the training highly on satisfaction and usefulness.


What’s next?

The module will continue to be used as part of clinician’s training in care escalation. Feedback from participating clinicians may be used to further refine the training, which could provide an opportunity for a larger-scale impact evaluation in the future.

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