Gottlieb Memorial Hospital Obstetrical Service Integration: Implementing Shared Quality Initiatives

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 ImprovementMaterial

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 insure NICU volume as more community hospitals have level 3 nurseries • Acquisition of Gottlieb Memorial Hospital (GMH) provided an Opportunity Confidential Quality ImprovementMaterial

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 • 2. Reduce elective inductions of labor (IOL) at GMH Confidential Quality ImprovementMaterial

4. Why reduce elective inductions? • The frequency of IOL has more than doubled rising from 9.5% to 21%. Source: www.cdc.gov, Aug. 2007 • Elective IOL is associated with: • -Increased instrumented deliveries • -Post-partum hemorrhage • -Longer labors • -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 • High Risk OB focus • IDPH recognized Level 3 OB, NICU, • Perinatal Center • Obstetrical ICU • Semi-private rooms • FY 08: 1463 Deliveries Gottlieb • Community hospital • Low risk OB focus • IDPH recognized Level 2 nursery • Excellent Mother-Baby rooming-in • Private rooms • FY 08: 590 Deliveries Confidential Quality Improvement Material

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

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

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

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 • Active engagement of physicians and nursing staff Next steps: • Continue IOL initiative • Expand pain management quality initiative to GMH patients Confidential Quality Improvement Material