Table 1. Principles of a Collaborative Labor and Delivery Team of Excellence and Patient Safety
PrincipleDescription
Team focusedResponsibility 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.
Clarify of responsibilityThe identity of the supervising provider and the team responsible for each case will be clear to all labor and delivery staff at all times.
CitizenshipInteractions 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. Frequent physical presence in the labor and delivery area will promote communication and collaboration among providers.
Acceptable case loadSafe 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's caseload exceeds this number, then the family medicine and obstetric attendings and certified nurse midwife will huddle to reallocate the case loads.
Maximizing continuityThe first option for assignment of the care provider in labor and delivery is the provider group with whom the woman has developed an established relationship during prenatal care. Information will flow smoothly from the prenatal to labor and delivery and postpartum and nursery providers and to the site and providers of mother and infant care after discharge from the hospital.
Frequent communicationFrequent communication is needed for safe provision of care and is promoted by regular interdisciplinary board rounds, ad hoc interdisciplinary updates with changes in plans or transfer among providers because of a change in risk status or patient load, and team members cross-covering for one another when needed.
Good documentationThere will be clear and consistent documentation of all care delivered. Comanagement or transfer of care from one team to another will be stated in the chart.
High efficiencyProviders should maximize the use of their skill set by caring for women whose needs match their highest level of training. The provider with the highest level of training should be caring for those women who need the highest level of care. Providers with a higher level of training should not be caring for women who can be cared for by professionals whose training is especially suited for those patient characteristics and preferences.
Evidence-based careCare provided will be based on the current evidence, standardized from one provider to another, and be informed by a rigorous CQI process.
Excellence in educationAs a teaching hospital, all team members have responsibility for the education of residents, students, and other trainees.
  • CQI, Continuous Quality Improvement.