1. 4. Acceptable Case Load Safe patient care is possible only if there are well rested providers responsible for a reasonable number of women in labor. No provider will be directly responsible for more than 3 women needing active management at any one time. If a provider caseload exceeds this number then the FM and OB attendings and CNM will huddle to reallocate the case loads. The charge nurse and the L&D staff will be notified of any change is responsibility. 5. Maximizing Continuity The first option for assignment of the care provider on L&D is the provider with whom the woman has developed an established relationship during prenatal care. Information will flow smoothly from the prenatal providers to L&D and postpartum providers, and to the nursery providers, and to the site and providers of post- hospital mother and infant care. 6. Frequent Communication Frequent communication is needed for safe provision of care and is promoted by: Board rounds with the entire team each AM and PM Nursing input at board and bedside rounds. “Meet and Greet” rounds after board rounds A dialogue among all providers and nursing when there is a change in plan or a woman is transferred to a different provider due to a change in risk status or patient load. Team members covering for one another when needed (e.g., in the OR, ED, performing a prolonged service, or off the floor). Notification of the charge nurse of change in coverage status. Principles of a Collaborative Labor & Delivery Teams of Excellence and Patient Safety at Boston Medical Center Partners: Department of Obstetrics and Gynecology, Department of Nursing, Program in Nurse Midwifery, Department of Family Medicine, Department of Anesthesia, Division of Neonatology, and Newborn Nursery Team Abstract Background: The participants met beginning in 2006 to discuss and to revise L&D procedures and policies. It was clear that defining the principles of collaborative teams was needed. Methods: The team used an iterative group process to create the principles of L&D group collaboration. Results: A list of 10 discrete, mutually reinforced principles of L&D collaboration were created. Conclusions: We hope that the principles of collaboration will foster an environment of teamwork that promotes excellence in patient care and patient safety. 7. Good Documentation There will be clear and consistent documentation of all care delivered: Women in active labor will be charted on at least q 2h. Notes include date, time, signature, printed signature and pager id #. Consultants will write a note directly in the chart. Co-management or transfer of care from one team to another will be stated in the chart. 8. High Efficiency The provider with the highest level of training should be caring for those women who need the highest level of care. Corollary: Providers with a higher level of training should NOT be caring for women who can be cared for by professionals whose training is especially indicated based on patient characteristics and preferences. 9. Evidence-Based Care Care provided will be: Based on the current evidence Be standardized from one provider to another Be informed by a rigorous CQI process 10.Excellence in Education As a teaching hospital, all team members have responsibility for the education of residents, students and other trainees. Chief residents will concentrate on high-risk women, the intern or junior resident will continue to discuss plan of care of low risk patients with the senior resident. All providers are responsible for orienting and teaching junior residents basic obstetrical management and flow on the floor. Our Mission To provide safe, high quality, patient centered care all the time. For more information, contact: A. Lee-Parritz., B Jack, T McMahan Boston Medical Center Boston University School of Medicine Boston, MA 02118 PRINCIPLES: L&D COLLABORATION 1. Team Focused Responsibility for care of women in triage, during labor and delivery, and during their postpartum stay rests with a team of professionals rather than a single provider. 2. Clarity of Responsibility The identity of the supervising provider and the team responsible for each case will be clear to all L&D staff at all times. 3. Citizenship Interactions between partners will be respectful and constructive. Excellence in patient care will be the focus of communication. All providers will perform patient care, order entry and chart documentation when appropriate and will update residents when they do so. Frequent physical presence on the L&D area rather than the call room will promote communication and collaboration among providers.