Excellence in Obstetrics A MULTI-SITE AHRQ DEMONSTRATION PROJECT Ann Hendrich, RN, PhD, F.A.A.N Vice President, Clinical Excellence Operations Executive Director, Patient Safety Organization September 2011

Ascension Health We are the largest Catholic health system, the largest private not-for-profit system and the third largest system (based on revenues) in the United States, operating in 20 states and the District of Columbia.

3 Ascension Health’s Vision

The Business Case for Perinatal Safety Potentially Preventable Birth Injury Events 77 Birth Injury Events were reported as Claims between 7/1/04 to 1/1/ (68%) of the 77 Birth Injuries were potentially preventable based upon clinical review. 6

The Business Case for Perinatal Safety Malpractice Cost Projections 76,000 Deliveries Per Year Approximately 30% of Exposures (Risk Adjusted) are Related to OB FY07 Obstetric Malpractice Expense was $36 Million 7

Demonstration Project Goals 1.Establish a uniform, evidence-based obstetrics practice model –Based on the idea that eliminating variability in obstetrics practice will translate to improved patient safety 2.Implement a quick-response liability model –Include standardized practices for identifying, reporting, responding to, investigating and disclosing medical errors and adverse outcomes 8

Demonstration Project Goals 3.Create the Ministry Intelligence Center (MIC)/OB Dashboard –IT infrastructure, portals, dashboards and data warehouses –Provide target sites and central administration with Key Performance Indicators –Allow ad hoc data queries and predictive modeling capabilities 9

Why Healing without Harm: A Multi-Site Demonstration Project to Develop New Models for Medical Liability and Improve Patient Safety Hypothesis What Decrease in shoulder dystocia injury rates and infant harm when the “bundle” is introduced Change in delays of treatment when fetal distress occurs and an increase in cesarean section effectiveness (necessity and timeliness) when the protocol guidelines are followed Reduction in the frequency and severity (settlement amount) of claims when full disclosure is implemented Increase in reporting of Serious Safety Events when 5 elements of High Reliability have been adopted Decrease in all birth trauma events and rates 10

Healing without Harm – Year One Major Milestones 593 nurses/physicians trained on multiple interventions 5,800+ mothers consented between January-Septmeber 2011 Average Consent Enrollment Rate at Five Sites– 88% Race/ethnicity breakdown of consented mothers –59% White –20% Black –9% Hispanic –2% Asian/Pacific –2% Other –7% Unknown

Healing without Harm – Year One Interventions for Clinical & Cultural Change Electronic Fetal Monitoring (EFM) e-learning module –202 physicians and 321 nurses trained Shoulder Dystocia Bundle and Training –Shoulder dystocia bundle tool developed –224 physicians and 349 nurses trained TeamSTEPPS TM and simulation training with hi-fidelity birthing simulators –243 physicians and 414 nurses trained Coordinated communication (disclosure) training –302 clinicians trained Cause Analysis training –76 clinicians trained

Healing without Harm – Year One Interventions for Clinical & Cultural Change

Event Response Model Obstetric Event Response Team Model Risk Manager Nurse Coder Neonate Provider Obstetrician System Reporting and Management 14

July 2010 Grant Start