Approximately seven infants out of every 1,000 live births in the United States suffered a birth trauma in 2001, according to the Agency for Healthcare Research and Quality. While rare, perinatal injuries devastate families and providers alike.

As part of a vision to lead America in clinical care, in March Fairview launched a systemwide initiative to assess and apply evidence-based practices to perinatal care, according to Stan Davis, MD, quality consultant, Fairview Southdale Hospital. Davis co-facilitates the project, along with Kristi Miller, RN, Fairview system director of clinical safety. Also involved are University of Minnesota Physicians including Dan Landers, MD, division head, Maternal-Fetal Medicine; Phillip Rauk, MD, Maternal-Fetal Medicine, Premier project lead; and Ted Thompson, MD, and Thomas George, MD, neonatologists. More than 60 obstetric physicians, nurses and administrative leaders attended a kick-off event. The goals are to:

• improve perinatal outcomes and patient experience
• develop, implement and measure best practices
• build high-performing clinical teams and
• manage costs and resources.

"This is our attempt to focus on outcomes, standardization and execution to achieve exceptional clinical care," says Fairview President and CEO Mark Eustis. "I see this as a pilot for other clinical improvements."

Beginning in April, teams from University of Minnesota Medical Center, Fairview's

Riverside campus and Fairview Ridges Hospital will represent the system in an 18-month Premier Perinatal Safety Initiative.

"The two sites will join 14 hospitals from around the country using care 'bundles,' interdisciplinary teams and communication skills to provide a model for spread of clinical standards," says Miller. Bundles include: Reassuring fetal status, pelvic exam prior to the start of oxytocin, and recognition and management of hyperstimulation. Elective induction also requires gestational age at or later than 39 weeks, while augmentation requires documentation of estimated fetal weight.

Early evidence suggests the bundles' success. In 2007, Ascension Health (Seton Hospital) reduced birth trauma by 85 percent from 2 per 1,000 births to 0.3 per 1,000 births. Charles F. Kettering Memorial Hospital reported a 69 percent reduction in Special Care Nursery admissions after implementing induction and augmentation bundles.

Going forward we will:

• develop perinatal policies and order sets
• establish baseline metrics and monitor performance
• set expectations for clinician behavior and accountability of processes using TeamSTEPPS™ and Just Culture principles
• participate in monthly Web seminars with Premier
• ensure participation of all Fairview hospitals.

For more information, contact Miller, 612-672-6157, kmiller5@fairview.org.

Please share your feedback on this story. Click on the feedback link below.