Changes Documented in the Hospitals Before and After the BTS, by the “4Rs” Clinical Steps
| Clinical Step (The 4Rs) | Before the BTS | After 17 months of the BTS |
|---|---|---|
| Recognize | MEOWS not included in existing tools and protocols for triage and vital signs monitoring in most participating hospitals | MEOWS was adopted across the hospitals. |
| Inconsistency among HCWs in interpreting the urgency to act when faced with abnormal vital signs and managing clinical situations | The HCW team is well-trained on tools and protocols using Job Instruction/TWI methods. | |
| Delayed critical interventions and compromised patient safety due to absence of a clear threshold for action | A clear threshold to act: if MEOWS score of 4 or greater, or a score of 3 in any single parameter, the HCW needs to ask if there is suspicion of sepsis or preeclampsia. With hemorrhage, the threshold is blood loss. | |
| Rescue | Predominant obstetrician-based decision-making | Team-based care and standardized. |
| Decision-making variable depending on HCW background experience and preferences | Leadership and frontline team trained in using data for decision-making and rapid cycle improvement. | |
| No QI capability to reflect on performance and improve systems of care | HCWs use improvement sciences to systematically improve the quality of care. | |
| Significant variations in clinical care due to unclear protocols and clinical decision-making | Collaborative agreement on best practices and evidence-based interventions reduces care variation. | |
| Reassess | No standard tools or process to reassess the patients after interventions | MEOWS is the gold standard for reassessing patients after implementing care bundles or clinical interventions. There is a clear process for communicating patient status to the care team. |
| Refer | No explicit standard tool during the transition of care | MEOWS is undertaken for all patients requiring care transitions with a clear recommendation to act. |
| No standard referral pathways | Streamlined referral pathways to ensure optimal patient care. |
Abbreviations: BTS, Breakthrough Series; HCW, health care worker; MEOWS, Modified Early Obstetric Warning Score; QI, quality improvement; TWI, Training Within Industry.