Lessons From Obstetric and Prenatal Safety Intervention Program (OPSIP)

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Slide 1

Lessons From Obstetric and Prenatal Safety Intervention Program (OPSIP)

ANN HENDRICH, RN, PhD, F.A.A.N.
Senior Vice President, Clinical Quality & Safety
CNO & Executive Director, Patient Safety
Organization

September 10, 2012

Images: Photographs show an infant's head cradled between two hands, an infant's hand grasping an adult's finger, and a woman wearing a white lab coat and stethoscope.

Slide 2

Introduction

Ascension Health, the nation's largest Catholic and nonprofit healthcare system, aims to demonstrate that implementing principles of High Reliability in five test sites across Ascension Health will lead to significantly improved patient safety and reduced medical liability in the high-risk practice of obstetrics.

Slide 3

Hypotheses

1. Decrease in shoulder dystocia injury rates and infant harm when the "shoulder bundle" is introduced.
2. 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.
3. Reduction in the frequency and severity (settlement amount) of claims when full disclosure is implemented.

Slide 4

Hypotheses continued

4. Increase in reporting of Serious Safety Events when five elements of High Reliability have been adopted:
   • Preoccupation with Failure.
   • Reluctance to Simplify.
   • Sensitivity to Operations.
   • Commitment to Resilience.
   • Deference to Expertise.
5. Decrease in all birth trauma events and rates.

Slide 5

Study Design

To demonstrate that implementing principles of High Reliability will lead to significantly improved patient safety and reduced medical liability in the high-risk practice of obstetrics.

Slide 6

Project Aims

1. Establish an evidence-based obstetrics practice model to improve patient safety.
2. Implement a quick-response liability model.
3. Develop a standard process for data collection, storage and analysis.

Slide 7

Labor & Delivery Units at Five Hospitals

Image: A map of the United States shows the locations of the 5 hospitals:

1. Sacred Heart Hospital on the Emerald Coast, Miramar Beach, Florida.
2. St. Vincent's Birmingham, Birmingham, Alabama.
3. St. John Hospital and Medical Center, Detroit, Michigan.
4. Columbia St. Mary's, Milwaukee, Wisconsin.
5. Saint Agnes Hospital, Baltimore, Maryland.

Slide 8

Data Collection

• >400 variables on mothers and infants.
• Training tracked with 'dose intensity' charts reflecting percentage of OB doctors and nurses trained.
• Reporting of OB-related Serious Safety Events in SafERSystem™.

Slide 9

Major Milestones

• 593 nurses/physicians trained in Year 1 on multiple interventions.
• 425 nurses/physicians trained in Year 2 on multiple interventions.
• 12,200 mothers enrolled in the study from 1/1/2011 – 6/30/2012.
• 85% average consent enrollment rate at five sites.

Slide 10

Consent Enrollment Rates by Site

Images: Four bar graphs compare consent enrollment rates for 5 hospitals.

Slide 11

Race and Ethnicity Ratio

Image: A pie chart shows the following data:

• White – 60.5%.
• Black – 21.5%.
• Hispanic – 9%.
• Asian/Pacific - 2%.
• Unknown – 5%.
• Other – 1.5%.
• Biracial – 0.5%.

Slide 12

Interventions

1. Electronic Fetal Monitoring e-learning module:
   • 277 physicians & 390 nurses trained.
2. Shoulder dystocia bundle and training. Shoulder dystocia bundle tool developed.
   • 281 physicians & 383 nurses trained.
3. TeamSTEPPS® and simulation training with hi-fidelity Noelle mannequins:
   • 409 physicians & 653 nurses trained.
4. Disclosure communication and cause analysis training:
   • 407 clinicians trained on disclosure & 76 trained on cause analysis.

Slide 13

Image: A photograph shows a pregnant woman lying on a delivery table; the obstetrical team is gathered around her, preparing for the delivery of the baby.

Slide 14

AHRQ Hospital—Decreased Occurence of Birth Traumas as Defined by AHRQ Birth Trauma PSI-17

Image: A line graph shows the number of live births and dates of birth trauma occurrences.

Slide 15

Obstetric Event Response Team (OBERT)

OBERT responds to unexpected adverse events within 24 hours

• Determines if care was reasonable or not.
• Shares (discloses) findings with patient/family.

Slide 16

Obstetric Event Response Team (OBERT)

Image: A large green circle is shown with five smaller circles spaced evenly around its rim. In each smaller circle is a photograph of a member of the OBERT team:

• Obstetrician.
• Nurse.
• Coder.
• Risk Manager.
• Neonate Provider.

At the center of the green circle is a small circle, containing a photograph of a woman cradling a newborn.

Slide 17

Results from April 1, 2011 – June 30, 2012

• 497 events reviewed by OBERT.
• 246 documented coordinated communications (disclosures):
  • 1 initiated by family.
  • 1 with no documentation.
  • 244 initiated by clinicians.
• Early results suggest fewer claims:
  • Notice of Intent/claim for event occurring after April 1, 2011.
  • Notice of Intent/claim for an event that occurred in October 2010 (prior to training).

Slide 18

Results from April 1, 2011 – June 30, 2012

• Ethnographer studying impact of coordinated communication on providers and patients/families.
• One medical liability carrier offers substantial premium discount to physicians who complete all mandatory training.