Excellence in Obstetrics A Multi-Site AHRQ Demonstration Project

1. Excellencein ObstetricsA Multi-Site AHRQ Demonstration Project Ann Hendrich, RN, PhD, F.A.A.N Vice President, Clinical Excellence Operations Executive Director, Patient Safety Organization September 2011

2. Ascension Health Facilities and Staff Locations 500+Acute Care Hospitals 70 Available Beds 17,836 Physicians 30,000 Financial Information (FY10) Total Assets $18 Billion Operating Revenue $14.8 Billion Operating Income $569 Million Net Income $1.2 Billion Investment $723 Million Care of Persons Who Are Poor and Community Benefit $1 Billion We are the largest Catholic health system, the largest private not-for-profit system and the third largest system (based on revenues) in the United States, operating in 20 states and the District of Columbia.

3. Ascension Health’s Vision 3

6. The Business Case for Perinatal Safety Potentially Preventable Birth Injury Events • 77 Birth Injury Events were reported as Claims between 7/1/04 to 1/1/06. • 52 (68%) of the 77 Birth Injuries were potentially preventable based upon clinical review. 6

7. The Business Case for Perinatal Safety Malpractice Cost Projections • 76,000 Deliveries Per Year • Approximately 30% of Exposures (Risk Adjusted) are Related to OB • FY07 Obstetric Malpractice Expense was $36 Million 7

8. Demonstration Project Goals 8 Establish a uniform, evidence-based obstetrics practice model • Based on the idea that eliminating variability in obstetrics practice will translate to improved patient safety Implement a quick-response liability model • Include standardized practices for identifying, reporting, responding to, investigating and disclosing medical errors and adverse outcomes

9. Demonstration Project Goals 9 Create the Ministry Intelligence Center (MIC)/OB Dashboard • IT infrastructure, portals, dashboards and data warehouses • Provide target sites and central administration with Key Performance Indicators • Allow ad hoc data queries and predictive modeling capabilities

10. 10

11. Healing without Harm – Year OneMajor Milestones • 593 nurses/physicians trained on multiple interventions • 5,800+ mothers consented between January-Septmeber 2011 • Average Consent Enrollment Rate at Five Sites– 88% • Race/ethnicity breakdown of consented mothers • 59% White • 20% Black • 9% Hispanic • 2% Asian/Pacific • 2% Other • 7% Unknown

12. Healing without Harm – Year One Interventions for Clinical & Cultural Change • Electronic Fetal Monitoring (EFM) e-learning module • 202 physicians and 321 nurses trained • Shoulder Dystocia Bundle and Training • Shoulder dystocia bundle tool developed • 224 physicians and 349 nurses trained • TeamSTEPPSTM and simulation training with hi-fidelity birthing simulators • 243 physicians and 414 nurses trained • Coordinated communication (disclosure) training • 302 clinicians trained • Cause Analysis training • 76 clinicians trained

13. Healing without Harm – Year One Interventions for Clinical & Cultural Change

14. Event Response Model Obstetric Event Response Team Model Obstetrician Nurse Neonate Provider Coder Risk Manager System Reporting and Management 14

15. July 2010 Grant Start