Best practice & research. Clinical obstetrics & gynaecology
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Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. ⋯ Given the complexity and acuity of critical care medicine, which often relies on more than one medical team, teamwork skills are essential. This chapter discusses the history and importance of teamwork in high-reliability fields, reviews key concepts and skills in teamwork, and discusses approaches to training and working in teams.
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High-profile inquiries in several countries have helped to raise public awareness of safety issues and driven policy change. In obstetric critical care, various publications have highlighted organizational factors, communication, absence of guidelines, failure to follow local protocols, poor documentation and delay in identifying the deteriorating woman as issues. ⋯ The principles of risk management and its various components can be used to make improvements. A framework to achieve this is as follows: building a safety culture; leading and supporting staff; integrating risk management activity; promoting reporting; involving and communicating with patients and the public; learning and sharing safety lessons; and implementing solutions to prevent harm.
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Best Pract Res Clin Obstet Gynaecol · Oct 2008
ReviewMultidisciplinary training in obstetric critical care.
Once identified, the critically ill obstetric patient will often fare well. Unfortunately, several recent publications show that many such patients are not identified and come to harm. Training for those caring for pregnant women has changed in recent years. ⋯ Other medical staff (anaesthetists, intensivists) may have experience of critical care in non-pregnant patients, but may be less aware of physiological changes of pregnancy that can affect how these patients are managed. The best way to address these issues is with multidisciplinary training, as highlighted in 'Safer Childbirth' and 'Saving Mothers Lives'. Such training allows each team member to understand his/her role and that of each of the other disciplines involved.
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Best Pract Res Clin Obstet Gynaecol · Oct 2008
ReviewCritical care in obstetrics: pregnancy-specific conditions.
This chapter summarizes the clinical presentation, pathophysiology, evaluation and management of six commonly encountered complications unique to pregnancy that require critical care management: obstetric haemorrhage; pre-eclampsia/HELLP (haemolysis-elevated liver enzymes-low platelets) syndrome; acute fatty liver of pregnancy; peripartum cardiomyopathy; amniotic fluid embolism; and trauma.
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The aims of critical care management are broad. Critical illness in pregnancy is especially pertinent as the patient is usually young and previously fit, and management decisions must also consider the fetus. Assessment must consider the normal physiological changes of pregnancy, which may complicate diagnosis of disease and scoring levels of severity. ⋯ There are also increasing numbers of pregnancies in those with high-risk medical conditions such as cardiac disease. As numbers are small and clinical trials in pregnancy are not practical, management in most cases relies on general intensive care principles extrapolated from the non-pregnant population. This chapter will outline the aims of management in an organ-system-based approach, focusing on important general principles of critical care management with considerations for the pregnant and puerperal patient.