Integrated Approach to Reduce Perinatal Adverse Events: Standardized Processes, Interdisciplinary Teamwork Training, and Performance Feedback.
OBJECTIVE
To improve safety practices and reduce adverse events in perinatal units of acute care hospitals.


METHODS
Primary data collected from perinatal units of 14 hospitals participating in the intervention between 2008 and 2012. Baseline secondary data collected from the same hospitals between 2006 and 2007.


METHODS
A prospective study involving 342,754 deliveries was conducted using a quality improvement collaborative that supported three primary interventions. Primary measures include adoption of three standardized care processes and four measures of outcomes.


METHODS
Chart audits were conducted to measure the implementation of standardized care processes. Outcome measures were collected and validated by the National Perinatal Information Center.


RESULTS
The hospital perinatal units increased use of all three care processes, raising consolidated overall use from 38 to 81 percent between 2008 and 2012. The harms measured by the Adverse Outcome Index decreased 14 percent, and a run chart analysis revealed two special causes associated with the interventions.


CONCLUSIONS
This study demonstrates the ability of hospital perinatal staff to implement efforts to reduce perinatal harm using a quality improvement collaborative. Findings help inform the relationship between the use of standardized care processes, teamwork training, and improved perinatal outcomes, and suggest that a multiplicity of integrated strategies, rather than a single intervention, may be essential to achieve high reliability.
School for the Science of Health Care Delivery, Arizona State University, Phoenix, AZ.
William
http://orcid.org/0000-0002-0968-4395
W
Riley
University of Minnesota, Minneapolis, MN.
James W
JW
Begun
Premier Insurance Management Services, Inc., San Diego, CA.
Les
L
Meredith
Fairview Health Services, Minneapolis, MN.
Kristi K
KK
Miller
KTConnolly & Associates, LLC, Charlotte, NC.
Kathy
K
Connolly
Premier Insurance Management Services, San Diego, CA.
Rebecca
R
Price
National Perinatal Information Center, Providence, RI.
Janet H
JH
Muri
School for the Science of Health Care Delivery, Arizona State University, Phoenix, AZ.
Mac
http://orcid.org/0000-0002-0070-4943
M
McCullough
Independent Perinatal Consultant, Edina, MN.
Stanley
S
Davis
D036861:Delivery, Obstetric / Q000379:methods / Q000592:standards; D030141:Feedback, Psychological; D005260:Female; D006761:Hospitals / Q000592:standards; D006801:Humans; D007318:Inservice Training / Q000379:methods / Q000592:standards; D033183:Interdisciplinary Communication; D019300:Medical Errors / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D064872:Patient Care Bundles; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D018743:Perinatal Care / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D011247:Pregnancy; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration; D000066477:Work Performance / Q000458:organization & administration / Q000592:standards
High reliability; in situ simulation team training; perinatal outcomes; quality improvement collaborative; standardized care processes