In the Literature

In the Literature: At Intermountain, process improvement reduces inductions, cesareans, NICU admissions, and costs

As a result of process improvement efforts bolstered by robust information systems, the proportion of all inductions that lacked strong indications for clinical appropriateness fell from 28 percent to less than 2 percent. The project also resulted in decreases in both NICU admissions and cesareans, and Intermountain estimates that the elective induction protocol reduces health care costs in Utah by $50 million per year.

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Filed in Blueprint, Clinical audit, case review, or analysis of adverse events, Clinical controversies, Clinical practice guideline/policy change, Health information technology, Health information technology, In the Literature, Payment reform, Performance measurement, Performance measurement/reporting on Fri., Jul 29, 2011

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In the Literature: Geisinger’s ProvenCare safely reduces cesarean rate with implementation of evidence-based guidelines

Geisinger Health Systems in Pennsylvania set out “to demonstrate that a large integrated health care delivery system, enabled by an electronic health record (EHR), could successfully reengineer a complicated clinical process, reduce unwarranted variation, and reliably deliver evidence-based care.” Geisinger has successfully demonstrated effectiveness in acute care specialties with their ProvenCare system and sought to adapt it to perinatal care, for the first time addressing a largely well population and integrating multiple outpatient clinics.

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Filed in Blueprint, Care coordination, Clinical controversies, Clinical practice guideline/policy change, Health information technology, Health information technology, In the Literature, New care delivery model, Performance measurement, Performance measurement/reporting, Strategies on Thu., Jun 16, 2011

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In the Literature: Intermountain Healthcare’s recurrent preterm birth consultation clinic is associated with improved care, outcomes

Intermountain Healthcare established a recurrent preterm birth prevention clinic in an effort to provide consistent, evidence-based medical care and education to women who have already experienced at least one prior spontaneous preterm birth and are at high risk for recurrent preterm birth. A retrospective cohort study evaluating the program found that referral to the clinic was associated with reduced likelihood of spontaneous preterm birth, longer gestation, and lower rates of neonatal morbidity.

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Filed in Blueprint, Care coordination, Clinical practice guideline/policy change, In the Literature, New care delivery model, Progress, Staffing/care coordination change on Tue., May 3, 2011

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In the Literature: A comprehensive perinatal patient safety program to reduce preventable adverse outcomes and costs of liability claims

After implementation of this comprehensive patient safety program, birth trauma rates decreased, the number of obstetrical occurrences (specified birth-related event or injury that may lead to a claim) decreased by 65%, and the average costs per obstetrical claim decreased. The number of new claims reported decreased by 48%.

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Filed in Clinical audit, case review, or analysis of adverse events, Clinical practice guideline/policy change, Educational materials for health professionals, Improved liability system, In the Literature, Performance measurement, Performance measurement/reporting, Risk management/liability reform, Staffing/care coordination change, Team building on Sun., Apr 3, 2011

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In the Literature: HCA reduces liability claims, cesarean sections with comprehensive patient safety approach

The general approach described in this article is the standardization of practices and protocols for several clinical situations associated with high risk of injury or harm, specifically use of oxytocin, misoprostol, or magnesium sulfate; operative vaginal delivery; and the management of shoulder dystocia and abnormal fetal heart rate tracings. In the period since the implementation of the comprehensive patient safety program, HCA saw a dramatic decrease in malpractice claims and loss rates. In addition, the primary cesarean section rate fell despite a generally liberal approach to operative delivery.

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Filed in Care coordination, Clinical audit, case review, or analysis of adverse events, Clinical practice guideline/policy change, Educational materials for health professionals, Health professions education, Improved liability system, In the Literature, Performance measurement/reporting, Risk management/liability reform, Team building on Tue., Mar 15, 2011

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In the Literature: Comprehensive patient safety program results in dramatic decrease in adverse events, 99% reduction in malpractice payments

New York Presbyterian Hospital-Weill Cornell Medical Center, a tertiary academic referral center in New York City, reports that following a multi-year, comprehensive patient safety program, sentinel events (maternal deaths and serious newborn injuries) decreased from 5 in 2000 to none in 2008 and 2009 while yearly compensation payments decreased from more than $27 million between 2003 and 2006 to $2.5 million between 2007-2009, a 99% reduction that far offset the cost of implementing the safety program.

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Filed in Blueprint, Clinical audit, case review, or analysis of adverse events, Clinical practice guideline/policy change, Educational materials for health professionals, Health information technology, Health information technology, Health professions education, Improved liability system, In the Literature, Progress, Risk management/liability reform, Skills training or drills for health professionals, Staffing/care coordination change, Team building, Workforce on Sun., Mar 6, 2011

In the Literature: A statewide initiative in Ohio reduces scheduled births before 39 weeks with no documented medical indication

A quality collaborative consisting of twenty hospitals in the state of Ohio representing 47% of all births in the state came together to reduce the number of scheduled births occurring before 39 weeks gestation without an appropriate documented medical indication. The collaborative reported that the rate of scheduled births taking place between 36 and 39 weeks gestation decreased significantly from 25% to <5% in participating hospitals in one year.

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Filed in Blueprint, Clinical controversies, Clinical practice guideline/policy change, Community education/outreach, Educational materials for health professionals, In the Literature, Performance measurement, Performance measurement/reporting, Team building on Sun., Mar 6, 2011

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