Institute for Healthcare Improvement: IHI Collaborative: Improving Perinatal Care

Overview

Formerly known as a Learning and Innovation Community, the Improving Perinatal Care Collaborative will build on lessons learned in the Community and continue to test changes that lead to lasting improvement in the perinatal topic area. This Collaborative is 12-months and begins in fall 2009.

Audio Listen to the July 28 informational call, led by faculty, regarding IHI’s upcoming Collaboratives. Review the presentation slides. Please note due to technical difficulties, the first two minutes of the call were not recorded. At this time, a general program description was presented.

New Program Content!

Teams with demonstrated reliability in the oxytocin bundles and teamwork and communications work will have the option of joining a new content area focused on improving the reliability of care for the mother and neonate during the second stage of labor.

Improvements made by participating organizations:

Middlesex Hospital, Middletown, Connecticut Note this is a 25-minute WebEx recording that includes slides.
Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania
HealthPartners Regions Hospital, St. Paul, Minnesota

Results for 39 Weeks: Iowa Health
In the spring of 2007, the hospitals, their key leaders, and key physicians gathered in Des Moines and established a city-wide policy for elective inductions and scheduled c-sections, agreeing that 39 weeks’ gestation is a given before an elective induction or repeat c-section is scheduled. I'm happy to report that this has been very successful. Last year in 2008, we had only four inductions scheduled less than 39 weeks out of 4,500 births at our organization. Those patient records went through peer review. Progress for sure!

Susan Gehlsen
Executive Director, Women's Services
Iowa Health - Des Moines

The Challenge

The Solution

Adverse events during labor and delivery can impose a heavy physical, psychological, and financial toll on the baby, family, care providers, and the community. Sound science that would allow us to deliver the best perinatal care is often known, yet is applied unreliably. Evidence-based guidelines for safe practices exist. The challenge is to ensure that these guidelines are applied to every patient, every time. Evidence-based care also relies on an effective, high functioning team, complemented by complete and accurate documentation of care provided. In the current model, training and education for physicians and nurses occurs separately. This Collaborative seeks to move to a model of shared multidisciplinary training in which all team members function together and are not afraid to speak up. When this happens reliably, adverse events have been shown to decrease as the system is now a learning system.

Based on innovation work currently underway, promising solutions for improving perinatal care include:

Applying IHI’s Reliable Design Model
Implementing the IHI Perinatal Bundles (Oxytocin: Elective Induction and Augmentation Bundles, Vacuum Delivery Bundle)
Adopting a common language for electronic fetal monitoring and training all members of the care team together in its use
Applying communication techniques such as appropriate assertion, conflict resolution, SBAR (Situation-Assessment-Background-Recommendation), and Crew Resource Management techniques
Adopting processes to understand and honor patient preferences
Collaborating with patients to better manage and reduce risk

IHI’s Perinatal Trigger Tool, used to identify and measure reduction of adverse events in the perinatal period, will assist teams in developing a focus for improvement that is specific to their local environment. Process measures support teams in developing a reliable delivery system and are developed by the team in consultation with Faculty to achieve their individual aim.

Areas of Focus

Structured according to the IOM aims for improvement to provide care that is safe, effective, patient-centered, timely, efficient, and equitable [Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.]
Organized in three improvement areas: Reduction of Harm, Teamwork and Communication, and Patient-Centeredness

New Content!

Teams with demonstrated reliability in the oxytocin bundles and teamwork and communication will have the option of joining a new content area focused on improving the reliability of care for the mother and neonate during the second stage of labor.

Aims Adopted by the Learning and Innovation Community:

Reduce preventable birth trauma to zero
Improve organizational culture of safety survey scores in perinatal units by 25 percent
Improve documentation and communication of care processes to reach 100 percent of internal standards for defensibility