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BACKGROUND

The labor and delivery unit is a dynamic environment with frequent interruptions and handoffs and a constant pressure to multitask. Along with the emergency department, it is arguably one of the most information-intensive environments where timely multidisciplinary communication is essential to safe and effective operations.1 Ineffective communication among clinicians has been implicated as a major contributor to adverse obstetric events. Review of closed claims malpractice cases identified communication as a contributing factor in 31% of adverse events where barriers included failure to function as a cohesive team.2

Use of a centralized whiteboard for communication, whether dry-erase or electronic, has the potential to aid collaboration and capture a whole picture to decrease adverse events, and optimize clinical and operational management.3 In Labor and Delivery Unit at Beth Israel Deaconess Medical Center (BIDMC), it has served as an invaluable instrument for communication and management of resources.

AIMS OF THE WHITEBOARD

  • To provide a quick high-level overview of the unit’s operation

  • To share up-to-date individual patient information or relay changes to patient management to all care teams (anesthesia, nursing, obstetrics)

  • To improve collaboration and coordination of patient care among all care teams

CLINICAL PRACTICE

The dry-erase whiteboard used for communication measures 6 × 5 feet and is partitioned into columns (Table 29-1). The columns are frequently updated to provide real-time patient information. For example, once a patient delivers, the membranes (M), cervical exam (CX), and time (T) fields are erased and the delivery time and method is noted. Or, if a patient is now going for a cesarean delivery (CD), these fields are erased and “for CD” is written.

TABLE 29-1Whiteboard on Labor and Delivery

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