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Improving Hospital Transfer Safety from Community-Based Births

Enhancing patient safety during transfers from planned community-based births through system protocols and collaborative efforts. Our mission is to promote safety and satisfaction in transfer experiences.

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Improving Hospital Transfer Safety from Community-Based Births

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  1. Enhancing the Safety of Hospital Transfers from Planned Community-Based Births A Quality Improvement Program at the Foundation for Health Care Quality Hospital Name Date of Presentation

  2. Disclosures The speakers have no conflicts of interest to disclose

  3. Support from: • Foundation for Health Care Quality – OB COAP • Washington State Hospital Association (WSHA) • Midwives’ Association of Washington State (MAWS) • Washington State Obstetrical Association (WSOA) • Washington State Department of Health (DOH) • Washington Affiliate of the ACNM • American Institutes for Research grant

  4. Members: Smooth Transitions Workgroup • Audrey Levine, LM– Co-Chair • Robin deRegt, MD – Co-Chair • Bob Palmer, MD – founding Co-Chair • Melissa Denmark, LM, CPM - Program Coordinator • Dale Reisner, MD – Swedish Medical Center • Ali Lewis, MD – Northwest Hospital • Michele Kulhanek – Assistant Director, Maternal-Infant Health Initiatives and Patient Safety at WSHA • Tiffani Buck, MSN, RN – Women’s Health & Perinatal Public Health Nurse Consultant – WA Department of Health • Marie Kaminskis, RN, BSN – Legacy Salmon Creek, Vancouver • Jamie George, CNM – Providence Regional Medical Center, Everett • Davia Loren, MD – University of Washington Medical Center • Greg Tryon – EMS representative • Rachel Wortman-Morris, PhD - Health Care Consumer/Advocate • Beth Arcese, LM, CPM • Frank Andersen, MD, Clinical Education Director, Ob/Gyn, WSU • Lisa Stotts, LM, CPM

  5. Smooth Transitions Mission: To address our shared responsibility for improving hospital transfers from planned community-based births to promote greater patient safety and satisfaction. Goals: • Improve the safety and efficiency of the transfer process through the establishment of system-wide protocols • Collect and analyze transfer outcome data for the purpose of quality improvement • Build greater collaboration between community-based midwives, EMS, and hospital care team • Enhance the patient experience of care when transfers occur

  6. ACOG Committee Opinion Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes (including) ready access to consultation and access to safe and timely transport to nearby hospitals. When antepartum, intrapartum, or postpartum transfer of a woman from home to a hospital occurs, the receiving health care provider should maintain a nonjudgmental demeanor with regard to the woman and those individuals accompanying her to the hospital. Committee Opinion Number 697, April 2017

  7. Intrapartum Transfers from Planned Community-Based Births • Nationally, intrapartum transfer rate ranges from 10.9% – 20% • Intrapartum transfer rate for nullips = 22.9%; rate for multips = 7.5% • 96.5% are non-urgent • 55.9% of IP transfers for prolonged labor, exhaustion, or maternal request for pain relief • 53.2% of those transferred deliver vaginally • Overall c-section rate for planned home births = 5.2% • Overall c-section rate for planned birth center births = 6.1% • Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D. & Vedam, S. (2014). Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Journal of Midwifery & Women's Health, 59, 17–27. • Stapleton SR, Osborne C, Illuzzi J. Outcomes of care in birth centers: demonstration of a durable model. J Midwifery Women’s Health. 2013;58(1):3–14.

  8. Postpartum and Newborn Transfers • 1.5% of mothers were transferred immediately postpartum, primarily for hemorrhage and retained placenta • 0.9% of newborns were transferred after birth, primarily for respiratory problems Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D. & Vedam, S. (2014). Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Journal of Midwifery & Women's Health, 59, 17–27.

  9. Perinatal Outcomes for Planned Community-Based Births • de Jonge, A., van der Goes, B.Y., Ravelli, A.C.J., Amelink-Verburg, M.P., Mol, B.W., Nijhuis, J.G., et al., 2009. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG: International Journal of Obstetrics & Gynaecology 116 (9), 1177–1184. • Birthplace in England Collaborative Group, 2011. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. British Medical Journal 343, d7400. • Hutton, E.K., Reitsma, A.H., Kaufman, K., 2009. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003–2006: a retrospective cohort study. Birth 36 (3), 180–189. • Bovbjerg ML, Cheyney M, Brown J, Cox KJ, Leeman L. Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States. Birth. 2017;44:209-221. https://doi.org/10.1111/birt.12288

  10. WA State Birth Data (2016) Total births * 90,310 Hospitals 83,781 92.8% Freestanding Birth Centers 1,419 1.6% Home Births 1,935 2.1% * Includes federal facilities, born on arrival, other unknowns WA State Department of Health, Center for Health Statistics, Health Utilization Tables (2016) – Natality Table C-5

  11. Licensed Midwives: Landscape in Washington State

  12. Overview of Smooth Transitions Program • Brief history • Presentations throughout Washington State and nationally • Successful models of program implementation

  13. Getting Started 1 2 3 4 Host a Smooth Transitions presentation Identify clinician champions Establish a Perinatal Transfer Committee Develop/adopt transfer tools

  14. Next Steps • Perinatal Transfer Committee meets 2-3x/year • Adopts Best Practice Transfer Guidelines http://www.homebirthsummit.org/wpcontent/uploads/2014/03/HomeBirthSummit_BestPracticeTransferGuidelines.pdf • Examines any trends with transfers; what’s working/not working • Explores opportunities for interdisciplinary skills training and continuing education based on identified needs • Address additional QI opportunities (for example: midwife-to-midwife transfers of care; timely access to prenatal ultrasound, ECV, PTL assessments)

  15. Taking Quality Improvement to the Next Level • Data collection & Analysis • Protected Case Review

  16. Thank You! Melissa Denmark Smooth Transitions Program Coordinator smoothtransitions@qualityhealth.org www.obcoap.org/smooth-transitions-initiative

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