Eliminating Birth Trauma at Ascension Health

Mazza, Frank; Kitchens, Judy; Kerr, Sue; Markovich, Anita; Best, Melody; Sparkman, Lora

doi:10.1016/s1553-7250(07)33003-1

Cited by 21 publications

(10 citation statements)

References 15 publications

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“…The normed incidence of 5min APGAR score <7 is reported as 0.7–1.6%; the incidence in our sample was 0.22% (Martin et al., ). Perinatal mortality rates compared favorably for our population at 2.2% for stillbirths and 0.4% for neonatal deaths, in comparison with the national data of 6.2% and 4.8%, respectively (Mazza et al., ). Our birth trauma rates were 0.2% compared with published data of 1.6–7.1% (MacDorman & Kirmeyer, ).…”

Section: Resultssupporting

confidence: 60%

Comprehensive Perinatal Safety Initiative to Reduce Adverse Obstetric Events

Wagner

Meirowitz

Shah

et al. 2012

Journal for Healthcare Quality

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A comprehensive perinatal safety initiative (PSI) was incrementally introduced from August 2007 to July 2009 at a large tertiary medical center to reduce adverse obstetrical outcomes. The PSI introduced: (1) evidence-based protocols, (2) formalized team training with emphasis on communication, (3) standardization of electronic fetal monitoring with required documentation of competence, (4) a high-risk obstetrical emergency simulation program, and (5) dissemination of an integrated educational program among all healthcare providers. Eleven adverse outcome measures were followed prospectively via modification of the Adverse Outcome Index (MAOI). Additionally, individual components were evaluated. The logistic regression model found that within the first year, the MAOI decreased significantly to 0.8% from 2% (p<.0004) and was maintained throughout the 2-year period. Significant decreases over time for rates of return to the operating room (p<.018) and birth trauma (p<.0022) were also found. Finally, significant improvements were found in staff perceptions of safety (p<.0001), in patient perceptions of whether staff worked together (p<.028), in the management (p<.002), and documentation (p<.0001) of abnormal fetal heart rate tracings, and the documentation of obstetric hemorrhage (p<.019). This study demonstrates that a comprehensive PSI can significantly reduce adverse obstetric outcomes, thereby improving patient safety and enhancing staff and patient experiences.

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Section: Resultssupporting

confidence: 60%

Comprehensive Perinatal Safety Initiative to Reduce Adverse Obstetric Events

Wagner

Meirowitz

Shah

et al. 2012

Journal for Healthcare Quality

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“…The data for this analysis come from only one hospital system and could not necessarily be generalized to all other systems or markets; however, our findings are consistent with our hypotheses and with the implications of prior research on perinatal quality improvement. 15,22 We do not include calculations of indirect costs or of program implementation in our analysis, but rather use an accounting perspective focused on revenues and costs associated with direct patient care. This analysis uses a hospital perspective, but hospital costs are only a fraction of the costs to society of adverse perinatal outcomes as a contributor to overall health care costs.…”

Section: Limitationsmentioning

confidence: 99%

A Perinatal Care Quality and Safety Initiative: Are There Financial Rewards for Improved Quality?

Kozhimannil

Sommerness

Rauk

et al. 2013

The Joint Commission Journal on Quality and Patient Safety

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Background There is increasing national focus on hospital initiatives to improve obstetric and neonatal outcomes. While costs of providing care may decrease with improved quality, the accompanying reduced adverse outcomes may impact hospital revenues. The purpose of this study was to estimate, from a hospital perspective, the financial impacts of implementing a perinatal quality and safety initiative. Methods In 2008, a Minnesota-based health system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which uses evidence-based care bundles to guide management of obstetric services. We conducted a pre-post analysis of financial impacts of ZBI, using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009–11) the initiative. Results After adjusting for relevant covariates, implementation of ZBI was associated with an 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (AOR=0.89, p=0.076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008. Conclusions Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering increased quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize quality improvement. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost.

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“…Programmes specific to perinatal safety using evidence to guide practice have been developed in response to increased numbers of adverse maternal and neonatal outcomes (The Joint Commission , , Mazza et al . , Macones et al . , Knox & Simpson ).…”

Section: Introductionmentioning

confidence: 99%

Caring nurse practice in the intrapartum setting: nurses' perspectives on complexity, relationships and safety

Glenn

Stocker-Schnieder

McCune

et al. 2014

Journal of Advanced Nursing

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Nurses at all levels of practice can use these perspectives to identify patterns in the complex adaptive healthcare system to improve quality and safety. Best practices include enhancing teamwork, implementing safety initiatives and promoting a Relationship-Based framework. Continued study of caring nurse practice could lead to establishment of additional safety and quality protocols vital to improving patient outcomes.

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Eliminating Birth Trauma at Ascension Health

Cited by 21 publications

References 15 publications

Comprehensive Perinatal Safety Initiative to Reduce Adverse Obstetric Events

Comprehensive Perinatal Safety Initiative to Reduce Adverse Obstetric Events

A Perinatal Care Quality and Safety Initiative: Are There Financial Rewards for Improved Quality?

Caring nurse practice in the intrapartum setting: nurses' perspectives on complexity, relationships and safety

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