The Department of Health & Human Services' Agency for Healthcare Research and Quality (AHRQ) has awarded a three-year demonstration grant for not-for-profit entities to Fairview Health Services in Minneapolis to extend a national collaborative that is reducing birth-related injuries.
“We're thrilled to have the opportunity to expand upon our learnings as we work to further reduce the incidence of these preventable injuries.”
The Premier healthcare alliance's Perinatal Safety Initiative is composed of 16 of the country's leading hospitals, representing 12 states, in which approximately 115,000 babies will be delivered over the course of the collaborative. The initiative, which will be extended through June 2013, seeks to significantly lower the incidence of certain infrequent, though serious, injuries that could result in a wide range of harmful outcomes, including birth asphyxia or permanent neurologic disability.
Through the first phase of the project (July 2008 through December 2009), participants:
- Reduced birth trauma (injuries to infants) by 11.6 percent against the baseline period (CY 2006 and 2007), and all participants were at or below the 2007 AHRQ provider rate.
- Reduced birth hypoxia and asphyxia, conditions that often cause infant brain damage, by 31.4 percent against the baseline period.
- Reduced the Adverse Outcome Index (AOI), by 6.4 percent against the baseline period. The AOI measures the number of deliveries with one or more of the identified adverse events as a proportion of total deliveries.
The initiative also included a supply chain audit by Premier consultants which identified nearly $1.3 million in total potential savings at 11 of the hospitals, an average of nearly $41 per delivery.
The AHRQ grant allows the Premier Perinatal Safety Initiative to continue with additional quality improvement and data analysis components. Fairview will provide focused training for high reliability team development through training in TeamSTEPPS and the use of medical simulation. Premier Insurance Management Services will analyze the impact on claim frequency and severity as a result of quality improvement, and will also provide significant risk management services to the participating hospitals.
"This initiative is achieving improvements through the use of consistent, reliable delivery of care bundles and clinical best practices," said Stanley Davis, M.D., Fairview Health Services, the lead researcher for the demonstration grant phase of the Perinatal Safety Initiative. "We're thrilled to have the opportunity to expand upon our learnings as we work to further reduce the incidence of these preventable injuries." Two Fairview hospitals - Fairview Ridges Hospital (Burnsville, Minn.) and University of Minnesota Medical Center, Fairview (Minneapolis) - are participating in the initiative.
The demonstration grant is part of the patient safety and medical liability initiative that President Obama announced during a September 9, 2009, address to a joint session of Congress. The grant was one of only seven large grants awarded nationwide.
Leveraging knowledge gained from similar initiatives, including a Premier/Institute for Healthcare Improvement collaboration, participating hospitals aim to improve their culture of safety, increase teamwork and improve communications among team members. The initiative is helping to prevent five recurring clinical issues that are commonly cited as being responsible for the majority of perinatal harm and associated costs, including obstetric professional liability insurance. These include:
- Failure to recognize an infant in distress;
- Failure to initiate a timely cesarean birth;
- Failure to properly resuscitate a depressed baby;
- Inappropriate use of labor-inducing drugs; and
- Inappropriate use of vacuum or forceps.
Use of care bundles is scored "all or none" in the initiative - meaning that to be credited with successful implementation of the care bundle, the care team must provide all care elements in the bundle. Simulations, sometimes using mannequins, are conducted for high-risk scenarios.
Participants are members of American Excess Insurance Exchange (AEIX), RRG, an excess professional liability insurer which funded the project. Premier Insurance Management Services, a wholly owned subsidiary of Premier, provides contracted management services for AEIX. Data concerning the participating hospitals' malpractice claims, events, and payouts for perinatal injury will be compiled and analyzed by Premier Insurance Management Services.
As part of the Premier Perinatal Safety Initiative, Premier has established an advisory committee of healthcare experts to garner guidance in undertaking the program and to ensure transparency.
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