A network of 14 hospitals collectively reduced the rate of neonatal birth trauma among deliveries in their facilities by 22 percent after the first two years of a program called the Premier Perinatal Safety Initiative.
The majority of the 4 million childbirths each year in the U.S. result in healthy mothers and babies. But in the 59,000 cases in which a serious birth complication occurs, it’s devastating to the family.
It’s also expensive. “Our data indicate that childbirths with complications cost twice as much as those without and increase the length of stay by 68 percent,” said Susan DeVore, president and CEO of the Premier healthcare alliance, a national network of 2,700 health systems.
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The aftermath is expensive too. In a 2012 survey of more than 9,000 obstetricians and gynecologists, more than 2,500 liability claims were reported in the obstetrics field. The average payment for the most commonly reported claim, a neurologically impaired infant, was nearly $1 million.
Aiming to cut some of the one-third of birth complications that are thought to be preventable, the alliance and an affiliated self-insurer, American Excess Insurance Exchange, launched the Premier Perinatal Safety Initiative in 2008.
Fourteen health systems across the country, including University of Minnesota Medical Center and Summa Akron City Hospitals in Ohio, implemented a set of best practices designed to overcome some of the issues that research has shown contribute to perinatal harm. Those included failure to initiate a timely Cesarean birth, inappropriate use of labor-inducing drugs, inappropriate use of vacuum or forceps and poor communication among caregivers.
Measures implemented included teamwork and communication training for staff, high-risk birth simulations and perinatal care bundles — or groups of evidence-based interventions related to a certain care process that produce better outcomes than when those interventions are implemented individually.
In the first, two-year phase of the project, participating hospitals saw a 25 percent reduction in birth hypoxia/asphyxia, which can cause infant brain damage, and a 22 percent reduction in neonatal birth injuries. They also reduced cardiac arrests and cardiac complications among mothers and cut instances of postpartum hemorrhage, the most common cause of perinatal maternal death, by 5.4 percent.
The first-phase data was released last week and compared against a baseline calculated from 2006 to 2008 data.
Tiffany Kenny, the informatics administrator for women’s health services at Summa, said the hospital put a focus on monthly high-risk delivery simulations, like the one in the video below, and stopped doing elective deliveries in mothers less than 39 weeks along (that’s when a mother chooses to be induced without a medical need).
As a result, they’re doing fewer elective inductions and have cut the time for inductions, from start to delivery, almost in half. That’s important because reimbursement is the same for all of those inductions, despite how long the mothers stay in the hospital, Kenny said.
The hospital system also reported a reduction in birth trauma of 72 percent.
Dr. Phillip Rauk of the University of Minnesota said the Fairview Health System, which includes the University of Minnesota Medical Center, had reduced NICU admissions from 7.9 per 1,000 births to 6.4 per 1,000 births during the first phase of the initiative.
Another trend in the overall data was a decrease in liability claims filed per delivery. While nonparticipating hospitals saw a 10 percent reduction in claims per delivery between 2006 and 2010, participating hospitals saw a 39 percent reduction. Participating hospitals also resolved two-thirds of those claims without payment in 2010, versus 13 percent during the baseline period. It’s worth pointing out, however, that there’s an obvious time lag between when care takes place and when claims are filed and resolved, so it’s hard to draw solid conclusions just yet.
For that we’ll have to wait for data from the second phase of the program, which will be complete at the end of 2012.
[Photo from Flickr user sabianmaggy]
