1. Washington State Perinatal Collaborative Update on Quality Improvement Initiatives  Elective Deliveries 37-<39 wks  Episiotomies  Breast Milk Feeding Thomas Benedetti, MD, MHA University of Washington Medical Center Department of Obstetrics and Gynecology and Jean O’Leary, MPH, RD Nutrition Consultant Washington State Department of Health WIC Nutrition Program November 19, 2013 Presented at Washington State Hospital Association Safe Table 11/19/2013

2. 90% reduction in Early Elective Deliveries between 37 to 39 weeks. $5 million in cost savings. Over 1,900 fewer early deliveries!

3. Percentage of Hospitals Under 5% by Quarter Baseline: 16% Q1 2011: 35.5% Q2 2011: 44.4% Q3 2011: 51.2% Q4 2011: 54.9% Q1 2012: 69.5% Q2 2012: 66.7% Q3 2012: 69.1% Q4 2012: 88.5% Q1 2013: 88.2%

4. Presented at Washington State Hospital Association Safe Table 11/19/2013

7. Optimizing Episiotomy Rates Review Methods and Components 2012-2013 l Statewide voluntary project l Regionally promoted by WSPC, WSHA-Partnership for Patients, PRN coordinators and physician champion l Measure: Episiotomy rate for spontaneous vaginal deliveries (National Quality Forum-based Measure; excludes shoulder dystocia, forceps, vacuum) l Distribute baseline vs. blinded hospital peer 2011 data to hospitals (WSHA Nov 2012: data source CHARS) l Hospitals will validate baseline data l 2012-2013 Target rate < 5 % (Note: target rate is Not 0%) l Quarterly 2012-2013 hospital rates provided by WSHA l Hospitals encouraged to track related episiotomy rate with instrument and third and fourth degree perineal lacerations Presented at Washington State Hospital Association Safe Table 11/19/2013