Boundary Trails Health Centre

Prior to 2019, 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.

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.

To facilitate best practice and excellent care in the delivery of twins at a level 1b hospital and to ensure optimal outcomes and nursing satisfaction with the process of delivering uncomplicated term twins.

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 the 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.

Success is determined by evaluating every twin delivery. Following each twin delivery, a debriefing session will take place. We will continuously assess how well our staff demonstrates their skills and comfort in delivering the best care for twins. We will encourage both the operating room and obstetrical staff to openly share their thoughts and concerns about the established procedures. All feedback will be carefully considered in order to make ongoing improvements.

• Education:
  • Held moreOB workshops/ACE days for staff focused on twin deliveries
  • Both the OR and Obstetrical teams engaged in reciprocal instruction. The OR team shared principles of maintaining sterility, setup, and procedure, while the obstetrical staff educated the OR team on vaginal delivery procedures, maternal and fetal monitoring practices, and post-delivery care. This exchange of knowledge has enhanced the understanding of the roles and responsibilities in both areas.
  • Planning and executing simulations
• Simulations: Conducting twin delivery simulations resulted in increased participant satisfaction and a clearer understanding. These simulations were highly regarded as valuable learning experiences. Action items were identified and addressed, boosting staff confidence in delivering care. These included formal role assignments for all involved staff, optimizing staff numbers as per actual needs, establishing a proper notification process, creating a job aid, and educating staff on the obstetrician’s preferences for twin delivery setup.
• Opportunities for feedback: Staff were encouraged to give their thoughts to the MOREOB core team so they could be brought forward to the Best Practice Committee. This feedback help form the draft policy.
• Reporting: moreOB reports were used to ensure staff reviewed the twin chapter as the policy was largely based on the best practice evidence in the moreOB chapter.
• Debriefs and meetings: The progress and success were shared on a monthly basis locally, and with regional obstetrical team. It was also posted on the moreOB website. The moreOB core team sent out the debriefs for the simulations via e-mail to all involved parties.
• Policy development: The Regional Obstetrical Educator worked with obstetricians to initially develop the policy. It was then reviewed by the surgical team, respiratory therapist, managers and CRN’s. All input was evaluated to ensure that the obstetricians and the anesthetists were aware and consulted.

The impact of this initiative is that BTHC now provides excellent care for uncomplicated twin deliveries, keeping these patient from having to travel to a far away community to have their delivery. Prior to this initiative, unexpected twin deliveries were occurring and the staff anxiety surrounding these occurrences has now greatly decreased. The staff are better informed in regards to the twin pregnancies in the area as a referral process has been set up where the obstetricians are made aware of all twin pregnancies and this information is then relayed to the obstetrical ward and the anesthetists.

By providing this service to our community we have been able to decrease ambulance costs, decrease costs to the region and the patient as well as increase patient satisfaction, all while providing safe and excellent care.

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 and provide excellent care for patients and their babies, while keeping 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!