New protocol streamlines labs, imaging and referrals
MultiCare women’s clinics reached an important milestone in 2025: the launch of a unified protocol that helps nurses and medical assistants streamline routine pregnancy care. After years of advocacy from frontline registered nurses, the team created a standardized process to ensure every pregnant patient receives the labs, imaging and referrals recommended by the American College of Obstetricians & Gynecologists (ACOG).
The work moved forward with support from Lisa Galbraith, MD, the women’s careline executive medical director. Dr. Galbraith championed the need for more consistent, efficient OB workflows across clinics.
Project leadership and team
The initiative involved frontline nurses and medical assistants from various clinics in the women’s careline. With the support of nursing and medical leadership, the project team secured approval for implementation for summer 2025.
Key members of the work group were from MultiCare Medical Associates, including Bryonna Kimball, RN (clinical coordinator), Megan Charboneau, RN (clinic manager), Erin Romero, MA (clinic manager), Samantha Hughes, MA (AVP, MedAc), and Jody Westing, RN (director of nursing).
How the protocol was developed
The team reviewed current workflows across clinics and compared them to ACOG standards and Washington State Department of Health guidance. They met biweekly to gather feedback from nurses, MAs, OB/GYNs and certified nurse-midwives, and to refine the workflow.
As the protocol neared completion, several teams — led by RNs — ran plan-do-study-act (PDSA) cycles to test the process in real time and identify the best integration point before expanding it to all clinics.
The new protocol organizes routine care around the standard schedule of pregnancy appointments and allows staff to proactively place orders for:
- Screening labs
- Routine imaging
- Standard referrals
By anchoring the process in ACOG recommendations, the protocol helps ensure evidence-based care for low-risk pregnancies and supports OB/GYNs and midwives by creating a more consistent foundation for each visit.
Empowering nurses and medical assistants
With the protocol in place, nurses can now order routine pregnancy screening during triage or care coordination when gaps are identified, reducing delays in care. Medical assistants are also empowered to place point-of-care tests and lab orders during office visits, helping providers focus on more complex patient needs.
This shift elevates both roles to the top of their scope of practice. It streamlines workflows and improves quality and efficiency for patients.
Outcomes and next steps
Early feedback from clinics has been overwhelmingly positive. The next phase of the work includes partnering with medical and informatics leaders to further optimize obstetric order processes in the medical record, a step that will add even more reliability and ease to pregnancy care workflows.
Written by: Jody Westing, RN, Director of Nursing, MultiCare Medical Associates