1. Gottlieb Memorial Hospital Obstetrical Service Integration: Implementing Shared Quality Initiatives Team Members: Dr. Gianopoulos Drs. Afshar, Alexandre, Ardakani, Furlin, Gomez, Jakimiec, Levi, Loya- Frank, Martinez, O’Malley, Pierce, Rudar, Smith Drs. Graziano, Deighan, Massey, Stoeffler, Wagner Gwen Loes, Sandy Swanson Nursing Staff of Gottlieb Memorial Hospital Birth Center Confidential Quality Improvement Material

2. Seize the Opportunity Women’s Health Strategic Plan  Need a competitive FACILITY for program growth  Need to grow low risk OB volume to support women’s health programs to support women’s health programs to insure NICU volume as more community to insure NICU volume as more community hospitals have level 3 nurseries hospitals have level 3 nurseries Acquisition of Gottlieb Memorial Hospital (GMH) provided an Opportunity Confidential Quality Improvement Material

3. Project Aim Statement  To transition Low Risk Obstetrics to GMH while developing shared quality initiatives to maintain Loyola quality in a community hospital setting.  Goals: 1. Increase low risk deliveries across the system system 2. Reduce elective inductions of labor (IOL) at GMH Confidential Quality Improvement Material

4. Why reduce elective inductions?  The frequency of IOL has more than doubled rising from 9.5% to 21%. Source: www.cdc.gov, Aug. 2007www.cdc.gov  Elective IOL is associated with: -Increased instrumented deliveries -Increased instrumented deliveries -Post-partum hemorrhage -Post-partum hemorrhage -Longer labors -Longer labors -Increased use of labor epidural -Increased use of labor epidural All of which increase cost Source: Grobman, W. Elective Induction: When? Clinical Obstetrics and Gynecology 2007 50(2): 537-546. Confidential Quality Improvement Material

5. Separate: Who we were Loyola Academic Health System Academic Health System High Risk OB focus High Risk OB focus IDPH recognized Level 3 OB, NICU, IDPH recognized Level 3 OB, NICU, Perinatal Center Perinatal Center Obstetrical ICU Obstetrical ICU Semi-private rooms Semi-private rooms FY 08: 1463 Deliveries FY 08: 1463 Deliveries Gottlieb Community hospital Community hospital Low risk OB focus Low risk OB focus IDPH recognized Level 2 nursery IDPH recognized Level 2 nursery Excellent Mother-Baby rooming-in Excellent Mother-Baby rooming-in Private rooms Private rooms FY 08: 590 Deliveries FY 08: 590 Deliveries Confidential Quality Improvement Material

6. Together: Who we are becoming Program Enhancements: Redesigned GMH Birth Center Redesigned GMH Birth Center Refurbished GMH Post- Partum -100% private rooms Refurbished GMH Post- Partum -100% private rooms Standardized policies and physician orders Standardized policies and physician orders Implemented shared quality initiatives Implemented shared quality initiatives Physician Partnerships: Dr. Gianopoulos leads as chair at both LUMC & GMH Dr. Gianopoulos leads as chair at both LUMC & GMH Recruited 4 Primary Care OB’s (PCOB) Recruited 4 Primary Care OB’s (PCOB) Credentialed 5 PCOB full time at GMH Credentialed 5 PCOB full time at GMH 24/7/365 PCOB on-site coverage 24/7/365 PCOB on-site coverage Loyola OB/Gyn residents rotate at GMH Loyola OB/Gyn residents rotate at GMH Confidential Quality Improvement Material

7. Post Partum open Birth Center Opened PCOB’s in house 24/7 Loyola/Gottlieb merger Confidential Quality Improvement Material

8. IOL education MDs/Staff Dr. Gianopoulos chair at GMH PCOB in house 24/7 Paper requisition implemented

9. Analysis and Next Steps Results:  GMH delivery volume has increased significantly for both the Loyola faculty practice and Gottlieb private practices.  GMH Elective IOL percent has decreased.  Project success factors: Consensus among several private practices Consensus among several private practices Active engagement of physicians and nursing staff Active engagement of physicians and nursing staff Next steps:  Continue IOL initiative  Expand pain management quality initiative to GMH patients Confidential Quality Improvement Material