Development of a Quality Indicator to Measure Urgent Requests to the Bedside

Abstract

ObjectiveTo develop a quality indicator describing the response time to an urgent request for a physician to the bedside of a pregnant or postpartum woman and to identify opportunities for improvement in care timeliness for women with worsening serious clinical conditions. DesignEvidence-based quality improvement project using the Iowa Model–Revised framework to develop a maternal care quality indicator. SettingLabor and delivery, antepartum, and mother/baby units in a large urban safety-net hospital preparing for a state level of maternal care designation survey. ParticipantsAll nurses and physicians caring for hospitalized pregnant and postpartum women participated in implementation. Intervention/MeasurementsPhysician response time was measured as the elapsed time from a nurse’s urgent request for a physician and the presence of a physician at the bedside of a woman in one of the identified units, as recorded in the electronic health record. ResultsPhysician response time to an urgent request to the bedside was documented 179 times during the first 3 months after implementation. Physician presence at the bedside within 30 minutes of a request was recorded in more than 99% of these events. ConclusionPhysicians’ responses to early warning signs within our facility were timely and within the parameters established by the Texas state-mandated criteria for a Level IV maternal care hospital. Response time as documented in the electronic health record provides an important quality indicator of maternal care in the inpatient setting.