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Premature Labor Assessment Toolkit(PLAT)

• Award Recipients:– James Byrne, M.D., Affiliated Clinical Professor in Maternal-Fetal

Medicine, Stanford School of Medicine, Chair, Department of Obstetrics and Gynecology, Santa Clara Valley Medical Center

– Herman Hedriana, M.D., Associate Clinical Professor, University of California, Davis, Partner, Sacramento Maternal-Fetal Medicine Medical Group

• Award Presenter:– John Wachtel, M.D., Chair, ACOG District IX, Adjunct Clinical

Professor, Stanford University Medical School May 3,

2015

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PLAT Goal

To improve perinatal health outcomes by establishing a standardized clinical pathway for the assessment and disposition of women with suspected signs and symptoms of preterm labor.

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History of the Preterm Labor Assessment Toolkit (PLAT)

• Project initiated at 2002 March of Dimes California Prematurity Summit to address:o Lack of standardized assessment process for preterm laboro Unnecessary maternal admissions and interventionso Need to ensure that women deliver at appropriate level of care for

improved outcomes

• Cooperative agreement between March of Dimes California Chapter and Sutter Medical Center, Sacramento (SMCS)

• Multidisciplinary statewide task force created• Statewide hospital survey examined consistencies and

variation in existing preterm labor policies/protocols

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PLAT Revision: 2011-2012• Enhancements include:

o Updated literature and best practices reviewo New content on preterm labor assessment standardization toolso Simplified algorithmo Data collection and quality improvement tools for hospitalso Clinical appendixo California pilot study evaluation reporto Hospital case studies

• Letters of support:o American Congress of Obstetricians and Gynecologists, District IX

(California), District XII (Florida), District VI (Illinois)o Association of Women’s Health, Obstetric and Neonatal Nurses

(AWHONN), California Section and National

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PLAT Contents• Assessment and Disposition Protocol • Clinical Algorithm• Order Set• Home Care Instructions• Patient Education• Implementation Checklist• Qualitative Baseline and Follow-Up Surveys• Chart Audit Tool• Clinician Power Point Training Presentation

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Why Use a Standardized Assessment for Preterm Labor?

• Helps avoid unnecessary interventions while providing reassurance to women who are not in preterm labor.

• Ensures pregnancies at highest risk receive beneficial treatments in a timely manner:o Antenatal corticosteroids to women before delivery to help

babies’ lungs develop. o Maternal transport (when needed), so that babies are born at

the appropriate level of hospital/NICU care.o Assembling a high-risk team of doctors and nurses.o Administering tocolytics to help postpone labor long enough to

carry out the interventions listed above.

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March of Dimes California Chapter Evaluation Study: 2008-2012

Evaluation question: Could PLAT implementation improve patient assessment, resulting in appropriate disposition decisions?

Data Source: Medical chart audit at 18 hospitals. Pre-implementation audit and post-implementation audit after 3 months.

Profile of 18 hospitals:• Range from 300 to 4,000 births/year

• 5 rural, 11 urban, 2 university

• Levels of care:o 6 Level I (basic)

o 9 Level II (community)

o 3 Level III (regional)

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PLAT Evaluation Conclusions

• PLAT implementation increased appropriate patient assessment by clinicians

• Standardization of practice increased

• Disposition decisions based on completed cervical change assessment increased

• Full compliance with the new protocol and procedures requires longer than 3 months