Preventable birth injuries cut after proven interventions are bundled

Liability claims were slashed at more than a dozen hospitals that participated in an initiative to curb serious adverse events during labor and delivery.

By — Posted Dec. 19, 2012

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Harm to mothers and their infants is significantly reduced when physicians, nurses and others follow protocols in the perinatal setting, a new study shows.

Between January 2008 and December 2010, 14 hospitals participating in the Premier Perinatal Safety Initiative, a collaborative of facilities from 12 states, reduced by 25% birth hypoxia and asphyxia that can cause infant brain damage. Neonatal birth trauma — from minor bruising to nerve or brain damage — was reduced 22%, according to results from the initiative published in December (link).

Mothers saw a 15% decrease in complications associated with anesthesia during labor and delivery, including events such as cardiac arrest and other complications. They also saw postpartum hemorrhaging, the most common cause of perinatal maternal death in the developed world, drop by 5.4%.

To achieve those numbers, the initiative used “care bundles,” groups of evidence-based interventions that are more effective when used together rather than individually, said Susan DeVore, president and CEO of Premier, a Charlotte, N.C.-based health care alliance of more than 2,700 hospitals nationwide working to improve patient care.

Physicians and others in the hospitals were directed to follow all the components outlined in the bundles that were established for three scenarios:

Elective induction. A gestational age of 39 weeks or more, a normal fetal status before administering oxytocin, a pelvic exam before oxytocin and recognition and management of tachysystole.

Augmentation. A documented estimated fetal weight, a normal fetal status, a pelvic exam before administering oxytocin and management of tachysystole.

Vacuum extraction. Alternative labor strategies considered, patient prepared, high probability of success, maximum application time and number of “pop-offs” predetermined and documented, cesarean and resuscitation teams available at delivery.

“While serious adverse events don’t happen often, when they do, it is devastating to the patient and to the families and to everyone around them,” DeVore said in a presentation of the results on Dec. 5. “All indications are if you implement these systematic processes and you can get compliance with the care bundles, it is leading to lower incidents of harm for both mother and baby, and it is leading to resolution of [liability] claims without payment and a lower level of claims filed.”

The study showed that the number of annual liability claims dropped 39% at participating hospitals, compared with a 10% drop in claims at nonparticipating hospitals. The 14 hospitals also saw 67% of claims resolved with no payouts. In the years before those hospitals implemented the safety initiative, they had resolved only 12% of the claims without payment.

The project reported on in December is winding up its second phase, focusing on further improving performance, examining hospital bundle compliance and associated outcomes, and evaluating the role of culture in perinatal performance improvement. The results are expected to be made available at the end of 2013.

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