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Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals
  1. Heather C Kaplan1,3,
  2. Susan N Sherman2,
  3. Charlena Cleveland3,
  4. Linda M Goldenhar3,
  5. Carole M Lannon3,
  6. Jennifer L Bailit4
  1. 1Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2SNS Research, Cincinnati, Ohio, USA
  3. 3James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  4. 4Division of Maternal Fetal Medicine and Center for Health Care Research and Policy, Metro Health Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
  1. Correspondence to Dr Heather C Kaplan, Perinatal Institute and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7014 Cincinnati, OH 45229, USA; heather.kaplan{at}cchmc.org

Abstract

Background Antenatal corticosteroids (ANCS) reduce complications of preterm birth; however, not all eligible women receive them. Many hospitals and providers do not have the right processes and conditions to enable ANCS administration with high reliability. The objective of this study was to understand conditions that enable delivery of ANCS with high reliability among hospitals participating in an Ohio Perinatal Quality Collaborative (OPQC) ANCS project.

Methods We conducted focus groups and semistructured interviews with members of the OPQC project team (n=27) and other care providers (n=70) using a purposeful sample of 6 sites involved in the OPQC ANCS project. Participants including nurses (n=57), attending obstetricians (n=17), physician trainees (n=21) and certified nurse midwives (n=2) were asked to reflect on their experiences and to identify factors contributing to optimal use of ANCS. Focus groups and interviews were transcribed verbatim and were analysed by a multidisciplinary team using an iterative approach that combined inductive and deductive methods to identify and categorise themes.

Results Six major themes supporting reliable implementation of ANCS at these hospitals emerged including: (1) presence of a high reliability culture, (2) processes that emphasise high reliability, (3) timely and efficient administration process, (4) multiple disciplines are involved, (5) evidence of benefit supports ANCS use and (6) benefit is recognised at all levels of the care team.

Conclusions Our findings identify the key processes and supports needed to ensure delivery of ASCS with high reliability and are reinforced by implementation and reliability science. They are useful for foundation of the successful implementation of other evidence-based practices at high levels of reliability.

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