Institute for Healthcare Improvement: Learning and Innovation Community: Improving Perinatal Care

Overview

Available through the IMPACT network or on a direct-enroll basis, IHI’s most intensive front-line improvement work happens in Learning and Innovation Communities. These are collaborative change laboratories in which teams from a wide variety of organizations work with each other and IHI faculty to rapidly test and implement meaningful, sustainable change within a specific topic area.

Listen to an informational call on this topic.

Download a brief description of this Community.

Read about the improvements made by two Community participants:

Improving Perinatal Care is available either through membership in the IMPACT network or through direct enrollment in the Community. Learn more about IMPACT.

The Challenge

The Solution

Adverse events during labor and delivery can impose a heavy physical, psychological, and financial toll on the baby, family, care providers, and the community. In 2005, obstetrical physicians were involved in 1,258 (down from 2004) obstetrics-related award payments at a mean payment of $523,534 and a median payment of $300,000. Physicians are not the only providers at risk. Nurses (including those that are registered, anesthetists, midwives, practitioners and advanced practice) were involved in over 90 award payments at a mean payment of $675,032 and a median payment of $288,752. [National Practitioner Data Bank 2005 Annual Report. US Department of Health and Human Services. Health Resources and Services Administration. Bureau of Health Professions: 61-64.] In part because of these statistics, insurance premiums for obstetricians and nurses have increased dramatically, forcing some practitioners to leave the practice of obstetrics and limiting access for expectant mothers.

Sound science that would allow us to deliver the best perinatal care is often known, yet is applied unreliably. Evidence-based guidelines for safe practices exist. The challenge is to ensure that these guidelines are applied to every patient, every time. Evidence-based care also relies on an effective, high functioning team, complemented by complete and accurate documentation of care provided. In the current model, training and education for physicians and nurses occurs separately. This Community seeks to move to a model of collaborative multidisciplinary training in which all team members function together and are not afraid to speak up.

Based on innovation work currently underway, promising solutions for improving perinatal care include:

Applying IHI’s Reliable Design Model
Implementing the IHI Perinatal Bundles (Oxytocin: Elective Induction and Augmentation Bundles, Vacuum Delivery Bundle)
Adopting a common language for electronic fetal monitoring and training all members of the care team together in its use
Applying communication techniques such as appropriate assertion, conflict resolution, SBAR (Situation-Assessment-Background-Recommendation), and Crew Resource Management techniques
Adopting processes to understand and honor patient preferences
Collaborating with patients to better manage and reduce risk

IHI’s Perinatal Trigger Tool, used to identify and measure reduction of adverse events in the perinatal period, will assist teams in developing a focus for improvement that is specific to their local environment. The Defensibility Tool is used to identify gaps in documentation of care that may hinder the defense of a medical malpractice case.

Areas of Focus

Structured according to the IOM aims for improvement to provide care that is safe, effective, patient-centered, timely, efficient, and equitable. [Crossing the Quality Chasm: A New Health System for the 21st Century. Committee on Quality of Health Care in America, Institute of Medicine, Washington, DC: National Academies Press; 2001.]
Organized in three improvement areas: Reduction of Harm, Teamwork and Communication, and Patient Centeredness

Aims

Reduce preventable birth trauma to zero
Improve organizational culture of safety survey scores in perinatal units by 25 percent
Improve documentation and communication of care processes to reach 100 percent of internal standards for defensibility