Seeing Double: A New Process for Twin Deliveries

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Doctor Ashley Dyson and Doctor Sahar Alhayjaa with a number of families that were able to deliver their twins at BTHC

Boundary Trails Health Centre recognized with 2018 Salus Global Patient Safety Award

Until last year, a pregnant person expecting twins in the Winkler, Manitoba area would be required to travel to another community for delivery in a tertiary centre. Having to travel can be scary and unsettling for some. For high-risk patients, travel can also add risk for the patient and their baby.

Dr. Ashley Dyson and her team at the Boundary Trails Health Centre (BTHC) became far too familiar with this reality and wanted to improve the client experience by allowing more mothers to deliver close to home. 

“Implementing twin deliveries is an opportunity to enhance patient-centred experiences. Keeping patients close to home and providing them with good care is important for the accessibility of safe, high quality care in the community,” said Dyson.

BTHC is considered a low-risk delivery site. However, with three obstetricians on staff alongside a very supportive labour and delivery team, Dr. Dyson felt that uncomplicated diamniotic dichorionic twin deliveries could safely be achieved at BTHC.

Working with MoreOB

Bringing twin deliveries in-house meant the creation of new policies and training for staff. One of the first steps was to bring the idea to Southern Health-Santé Sud’s Regional Medical Advisory Committee. An environmental survey demonstrated that BTHC would be able to provide this service and maintain safe care. Once the team had the go-ahead, a policy was created, reviewed by all teams involved, and approved by the region.

The twin-deliveries initiative was mostly driven by the BTHC Obstetrical Practice Group. This team knew the patients would have the best outcomes if staff were well trained to deliver twins and how to identify and know what to do in emergency situations. To address this need for specialized training, expertise was sought from the Salus Global’s MoreOB program.

HIROC, the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Canadian Medical Protective Association (CMPA) share equal ownership in Salus Global – a partnership rooted in the shared value of creating the safest healthcare system. MoreOB, Salus Global’s flagship program, is designed to create a culture of patient safety in obstetrical units.

MoreOB is being used in hospitals across Southern Health-Santé Sud and was initially brought to BTHC in 2013. In the past five years, the BTHC team has leveraged the program to enhance knowledge, communication and teamwork skills.

Training through Simulation

The role that MoreOB plays is centred around three pillars: interprofessional teamwork, a Continuous Quality Improvement (CQI) framework, and the application of validated and effective approaches (Simulation, Debriefing, etc.). 

A large part of MoreOB’s involvement in the BTHC twin delivery initiative was education around policy and simulation. The simulations were about ensuring all staff were exposed to:

  • Monitoring both babies
  • Documenting
  • Alerting the team (obstetrician, OR staff, anesthetist, etc.)
  • Moving the patient to the OR
  • Setting up for both vaginal delivery and cesarean section

Throughout the simulations, staff were able to ask questions and to engage in important discussions such as, when a cesarean section is required and who makes the call. The goal is to facilitate education around the policy and open communication.

The simulations brought to light issues around the need for a shared-understanding of roles between OR staff and obstetrical staff.

“The OR staff learned what is involved with vaginal births while the obstetrical staff learned more about what is involved with cesarean sections,” said Dr. Dyson. “Both teams now have a much better understanding of each other’s roles. This has fostered increased knowledge and respect between the two units.”

Overall, not only did the teams become more confident providing safe care to their patients, they also developed stronger interpersonal relationships and learned to appreciate the roles and responsibilities of each area.

Awarded for Excellence

Since the program was implemented in 2018, BTHC has received positive feedback from the community and staff. As a result of their work and success regarding the initiative, BTHC was recognized with a Salus Global Patient Safety Award in May 2018. The BTHC team is proud to offer safe twin deliveries, to provide excellent care for patients and their babies, and to keep families close to home.

“We are very proud of the work being done at Southern Health-Santé Sud,” said Catherine Gaulton, CEO of HIROC. “It’s amazing to see our subscribers innovate to create safer care settings through the MoreOB program.”

Inspired by the BTHC initiative, two other Southern Health-Santé Sud sites are planning to implement obstetrical triage on their wards where MoreOB simulations will also become a part of their standard training processes.

Congratulations Boundary Trails Health Centre!

This article was originally published in The HIROC Connection and reproduced with permission from HIROC.

Click here to view the Fall 2019 issue of the HIROC Connection.