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Staff at SSM Health St. Mary's Hospital in St. Louis used AHRQ’s TeamSTEPPS training to improve their teamwork and communication, helping them to reduce the Cesarean section (C-section) rate for low-risk, first-time mothers to 12 percent. TeamSTEPPS is an evidence-based teamwork and communication system designed to improve quality, safety, and efficiency of health care.

TeamSTEPPS has helped strengthen St. Mary’s communications, making interactions more frequent and effective, so the staff can stay on top of developing events to avoid C-sections whenever possible

"Everyone at St. Mary’s who works in inpatient units is TeamSTEPPS-trained. About 80 percent of the hospital’s clinical department staff (e.g., pharmacy and radiology) is also trained in TeamSTEPPS. We really reinforce the importance of huddles, briefs, and debriefs to keep us all on the same page," said Pam Lesser, R.N.C., M.S., director of perinatal services at the hospital.

The hospital first implemented the labor and delivery segments of TeamSTEPPS in 2007 in the obstetrics (OB) department. Since then, Lesser said, every perinatal TeamSTEPPS training class has been an interdisciplinary, OB-specific version. St. Mary’s manages about 3,400 deliveries a year in 13 labor rooms, 2 operating rooms, and additional high-risk pregnancy beds.

For every labor and delivery patient, the charge nurse and chief resident lead an interdisciplinary team review that includes nurses, obstetricians, neonatologists, and anesthesiologists on each shift. Frequent meetings or “huddles” are held to discuss patients’ progress and conditions.

Based on principles from high reliability organizations, huddles are used to improve safety in hospitals, mainly by fostering communication and interdisciplinary relationships, while enhancing safety culture. Labor and delivery units are high-risk environments where one miscommunication can lead to care breakdowns. Huddles help reduce communication errors and provide debriefing opportunities to learn from incidents.

St. Mary’s teams meet at least once per shift as a group to review every patient in their care, which includes labor and delivery as well as those in the perinatal special care unit, the ICU, and behavioral health units. The charge nurse initiates huddles with the OB residents, presenting the care management plan with input from the bedside nurse regarding individual patient issues. The outcome of these meetings is a discussion of whether things are on track and what needs to be addressed or adjusted, thus resulting in a shared mental model.

“We needed TeamSTEPPS to communicate about our patients and to keep care patient-centered, yet safe,” said Lesser. “We include patients when we do bedside handoffs as nurses change shifts. Every shift, we're updating and asking patients, ‘Are we on the right course for what you want?'"

“We saw the need to address C-sections when moms were coming in with very risky deliveries after having had a C-section with their first child. If we can avoid the first C-section, subsequent deliveries are much safer and easier,” Lesser explained.

Thanks to the TeamSTEPPS-trained staff, however, having a first C-section doesn’t mean a mother is automatically destined for surgical deliveries of future children. At St. Mary’s, about 75 percent of women who have had C-sections for their first deliveries are able to successfully deliver subsequent children vaginally. This rate even includes women who have had more than one C-section.

These successes rest on an important element: communication that is effective and ongoing. “Our teams trust each other and are used to talking to each other all the time,” Lesser said, “thanks to TeamSTEPPS.”