Reduction of Peripartum Racial/Ethnic Disparities (+AIM)

Home Patient Safety Bundles Reduction of Peripartum Racial/Ethnic Disparities (+AIM)
Readiness

Every Health System

  • Establish systems to accurately document self-identified race, ethnicity, and primary language.
    • Provide system-wide staff education and training on how to ask demographic intake questions.
    • Ensure that patients understand why race, ethnicity, and language data are being collected.
    • Ensure that race, ethnicity, and language data are accessible in the electronic medical record.
    • Evaluate non-English language proficiency (e.g. Spanish proficiency) for providers who communicate with patients in languages other than English.
    • Educate all staff (e.g. inpatient, outpatient, community-based) on interpreter services available within the healthcare system.
  • Provide staff-wide education on:
    • Peripartum racial and ethnic disparities and their root causes.
    • Best practices for shared decision making.
  • Engage diverse patient, family, and community advocates who can represent important community partnerships on quality and safety leadership teams.
Recognition & Prevention

Every patient, family, and staff member

  • Provide staff-wide education on implicit bias.
  • Provide convenient access to health records without delay (paper or electronic), at minimal to no fee to the maternal patient, in a clear and simple format that summarizes information most pertinent to perinatal care and wellness.
  • Establish a mechanism for patients, families, and staff to report inequitable care and episodes of miscommunication or disrespect.
Response

Every Clinical Encounter

  • Engage in best practices for shared decision making.
  • Ensure a timely and tailored response to each report of inequity or disrespect.
  • Address reproductive life plan and contraceptive options not only during or immediately after pregnancy, but at regular intervals throughout a woman’s reproductive life.
  • Establish discharge navigation and coordination systems post childbirth to ensure that women have appropriate follow-up care and understand when it is necessary to return to their health care provider.
    • Provide discharge instructions that include information about what danger or warning signs to look out for, whom to call, and where to go if they have a question or concern.
    • Design discharge materials that meet patients’ health literacy, language, and cultural needs.
Reporting/Systems Learning

Every Clinical Unit

  • Build a culture of equity, including systems for reporting, response, and learning similar to ongoing efforts in safety culture.
  • Develop a disparities dashboard that monitors process and outcome metrics stratified by race and ethnicity, with regular dissemination of the stratified performance data to staff and leadership.
  • Implement quality improvement projects that target disparities in healthcare access, treatment, and outcomes.
  • Consider the role of race, ethnicity, language, poverty, literacy, and other social determinants of health, including racism at the interpersonal and system-
    level when conducting multidisciplinary reviews of severe maternal morbidity, mortality, and other clinically important metrics.
  • Add as a checkbox on the review sheet: Did race/ethnicity (i.e. implicit bias), language barrier, or specific social determinants of health contribute to the morbidity (yes/no/maybe)? And if so, are there system changes that could be implemented that could alter the outcome?

© 2016 American College of Obstetricians and Gynecologists. Permission is hereby granted for duplication and distribution of the bundle document, in its entirety and without modification, for solely non-commercial activities that are for educational, quality improvement, and patient safety purposes. All other uses require written permission from ACOG.

Standardization of health care processes and reduced variation has been shown to improve outcomes and quality of care. The Council on Patient Safety in Women’s Health Care disseminates patient safety bundles to help facilitate the standardization process. This bundle reflects emerging clinical, scientific, and patient safety advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Although the components of a particular bundle may be adapted to local resources, standardization within an institution is strongly encouraged.

The Council on Patient Safety in Women’s Health Care is a broad consortium of organizations across the spectrum of women’s health for the promotion of safe health care for every woman.

October 2016

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