As part of a larger program to achieve zero preventable birth injuries, this project’s goal was to avoid tachysystole or appropriately intervene when tachysystole occurred. Tachysystole is defined as more than 5 contractions in 10 minutes, averaged over a 30-minute window, and is often associated with induced or augmented labor.
Clinical practice guideline/policy change
As a Patient-Centered Maternity Home, two components of our Maternal-Child Health Care are evidence-based practice and shared decision-making. While ACOG guidelines are not always evidence-based, they have recently released guidelines allowing us all to offer trial of labor to women with two prior cesareans or twins. Our cesarean rate is 19% and our VBAC rate is 50%. North Carolina Medicaid is currently reimbursing cesarean birth at the same rate as vaginal birth.They were proactive in setting the rates pretty close to each other in years past.
In the Literature: San Francisco General Hospital implements skin-to-skin care in the operating room for mothers and infants after cesarean surgery
The improvement team altered the process of care in the operating room to enable routine, early skin-to-skin contact after cesarean birth, with the aim of increasing the success of breastfeeding initiation.
For all scheduled cesarean deliveries, the hospital introduced a preoperative checklist to verify patient identity, indication for caesarean section, allergies, and presence of neonatology staff and a postoperative check to verify analgesia, oxytocic prescription, antibiotics, thromboprophylaxis and skin contact between mother and baby. Researchers examined staff attitudes before and after introduction of the checklists, checklist compliance, and whether patients experienced anxiety or were reassured by the process.
From the Field: Eliminating Preventable Perinatal Injuries and Reducing Malpractice Claims and Costs: Creating High Reliability Obstetrics Units
We intend to reduce perinatal harm and decrease malpractice events by eliciting improved compliance in 4 clinical care bundles and implementation of an evidence-based simulation training methodology focused on improving clinical staff’s ability to work in teams. We are measuring our impact through a culture of safety survey and a high reliability survey, various outcomes measures.
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.
NH Patient Voices’s mission is education and advocacy for safe, quality, compassionate healthcare that puts patients & their families at the center of care in both policy and practice. Since 2005, we’ve worked tirelessly to bring the collective voice of patients to healthcare providers, administrators, legislators, public policy, and public health leaders.
The Postpartum Depression Task Force of Monroe County seeks to improve identification and treatment for women with perinatal mood disorders. The Task Force is a coalition of providers from all aspects of maternal-child health, including doctors, nurses, psychiatrists, psychologists, social workers, doulas, childbirth educators, hospital and medical office administrators, and consumers. Measures include attendance at continuing education events; numbers of in-services and outreach events; as well as improved identification and referral systems within the hospital as well as in the community.
We wanted to design a center where the needs of the mother and the baby come first. A place where every aspect of care is based on supporting natural birth and breastfeeding.
James’s Project sets out to reduce the US infant mortality rate and improve maternal health by raising awareness of patient safety issues in these areas. This is done by using the tools of education, communication and collaboration.