Table 1

Three plan-do-study-act (PDSA) cycles used to learn about the feasibility and effectiveness of setting up an observation room

PDSA 1Spend one afternoon timing how long it takes to assess women who are in the planned observation room compared with women elsewhere on the ward.As plannedIt took roughly 5 min to assess women in the observation room compared with roughly 20 min to assess women elsewhere on the ward.Set up the observation room and reorganise patient flow so that women go there after delivery.
Test the feasibility of this new set up over 2 days.
PDSA 2Over the course of 2 days, learn from nurses if the new observation room reduces work load and makes assessment easier.As plannedNurses felt the new set up was better for them and made their work easier.
One of the nurses suggested involving patients and families in identifying danger signs.
Educate all women and family members entering the observation room about danger signs.
Conduct a longer PDSA cycle to learn if the observation room and patient education system maintains the number of assessments and increases the number of women being identified with complications
PDSA 3Continue with the new observation room and patient education system for 4 weeks (until the end of June 2017) and measure the number of assessments per patient and the number of women being identified with complications to learn if the system leads to better care.As plannedWoman were assessed more than six times in the first 6 hours. Five (1.6%) of the 313 women who delivered were identified with complications (compared with 0.12% of women before this change). The nurses felt that their workload was decreased.Continue with the observation room and patient education system.
Stop collecting data on the number of assessments.
Continue to track the proportion of women identified with complications and re-evaluate if that decreases.