From the Field: Michigan Health and Hospital Association Keystone: OB

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Project Title

Michigan Health & Hospital Association – Keystone: OB

Name of Organization, Agency, or Institution

MHA Keystone Center for Patient Safety & Quality

Primary Contact Name and Title

Morgan Martin, Project Coordinator

Project Aim and Goals

Keystone: OB focuses on preventing elective inductions and elective cesareans before 39 weeks. We are also focused on assuring safe care during labor induction, augmentation, and the second stage of labor. In addition, we provide recommendations on electronic fetal monitoring, and most importantly improving the culture of safety in the unit.  We are measuring structure, process, and outcome measures which relate to each of these interventions. Our measures include elective inductions before 39 weeks, elective cesareans before 39 weeks, compliance with all aspects of care during labor induction, augmentation and second stage of labor, transfers to a higher level of care, babies with Apgar scores less than 7 at 5 minutes, and babies with umbilical artery cord gases less than pH 7.10. We also measure safety culture using the Safety Attitudes Questionnaire.

Blueprint Area(s) Addressed

Strategies Used


We have seen a strong reduction in the percentage of elective inductions before 39 weeks and elective cesareans before 39 weeks throughout the state of Michigan. We have seen a reduction in babies born with Apgar Scores less than 7 at 5 minutes. This project has shown great improvement in percent compliance with recommendations for safe labor care during induction, augmentation, and second stage of labor. We have also experienced improvement in the safety attitude scores on the unit.

Articles About the Project

An evidence-based approach is born (PDF, Modern Healthcare, 12/20/10)

Statistics show c-section rates depend on where mom lives (Grand Rapids Press, 11/8/10)

Toolkits for Project Implementation or Replication

Available by request. Contact Morgan Martin at

For More Information

Filed in Clinical audit, case review, or analysis of adverse events, Clinical controversies, Clinical practice guideline/policy change, Educational materials for health professionals, Performance measurement, Performance measurement/reporting, Stories from the Field, Team building on Thu., Mar 17, 2011

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