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Welcome! Wave 2 - Group Webinar #4
Decreasing births < 39 weeks gestation without
medical indication and improving birth
registry accuracy project
Ohio Perinatal Quality Collaborative
Ohio Department of Health, Office of Vital Statistics
Ohio Hospital Association
September 23, 2013
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Agenda Time Topic
Presenter
Noon Welcome , roll call, and review of Agenda Susan Ford
12:10 pm
Data Review:
• Aggregate data chart
• Monthly Aggregate Chart Review
Michael Krew, MD
12:15 pm Month 4 in review
• Feedback from Learning Session
Susan Ford
12:25 pm Variables of the Month:
• Augmentation
• Induction
Judy Nagy
Michael Krew, MD
12:35pm Birth Registry Accuracy:
• PDSA Sharing – EMR Use by the Unit Clerk
• The use of EMR’s in abstracting birth data
Jane Pierce, UVMC
Lynette DeBertrand,
East Ohio Regional
12:45 pm Team Sharing & Discussion Susan Ford
12:55 pm
Next steps…
Susan Ford
Wave 2 teams
• Bellevue Hospital
• Community Hospitals and
Wellness Centers
• East Ohio Regional Medical
Center
• Highland District Hospital
• Madison County Hospital
• Marietta Memorial Hospital
• Marion General Hospital
• MedCentral Health System –
Mansfield
• Memorial Health Care System
• Mercer County Joint Township
Community Hospital
• Mercy St. Charles Hospital
• Northside Medical Center
• O’Bleness Memorial Hospital
• ProMedica Flower Hospital
• ProMedica St. Luke's Hospital
• Pomerene Hospital
• Southwest General Medical
Center
• St. John’s Medical Center
• Trumbull Memorial Hospital
• Upper Valley Medical Center
• Van Wert County Hospital
• Wilson Memorial Hospital
In 9 months,
reduce to 5% or
less, the number
of women in Ohio
of 37.0 to 38.6
weeks gestation
for whom delivery
is scheduled in the
absence of
appropriate
medical indication
OPQC: Decreasing births < 39 weeks gestation without medical indication and improving birth registry accuracy project
Awareness of risks & expected benefit of scheduled delivery prior to 39.0 weeks
by patients and other consumers
Dating criteria: optimal estimation of
gestational age
Hospital and physician practice
policies that facilitate ACOG criteria
Awareness of risks & expected benefit of near-term delivery
by clinician
Culture of safety and improvement
• Inform consumers of risk/benefits of deliveries < 39 weeks
• Communicate to patient/clinic/hospital ultrasound results
• Promote need for early dating to practitioners and consumers
• Public awareness campaign
Promote need for early dating to practitioners and consumers
Promote sonography < 20 weeks to establish dates
Document criteria used to establish EDC
Appropriate use of fetal maturity testing
Empower nurses /schedulers to require dating criteria
Identify a specific contact for authorization dispute re: dating
Provide patient with hard copy results of ultrasound
• Empower nurses /schedulers to require dating criteria
• Document rationale and risk/benefit for scheduled deliveries at 37.0
to 38.6 weeks gestation
• Document discussion with patient about the above
• Both patient and MD sign consent statement for scheduled delivery
between 37.0 and 38.6 weeks
• Physician awareness campaign: what are the reason(s) for
scheduled delivery?
• Maximize access to Delivery and OR for optimal scheduling
• Facilitate scheduling policies that respect ACOG criteria
• Prenatal caregivers receive feedback from postnatal caregivers
about neonatal outcomes of scheduled deliveries
• Ensure complete and accurate handoffs OB/OB and OB/Peds
• Document discussion with patient about risk/benefits of near-term
delivery
• Promote need for early dating to practitioners and consumers
• Continuous monitoring of data & discussion of this effort in
staff/division meetings.
• Project outcomes posted on units and websites.
• Develop ways to include staff and physician input about
communications and handoffs
• Connect with organizational initiatives on safety and use existing
approaches as possible
• Empower nurses/schedulers to require data criteria
Aim
Key Drivers
Interventions
Goal: Assure that all initiation of labor or caesarean sections on women who are not in labor occur only when obstetrically or medically indicated
Revised: 1.31.13
OPQC: Decreasing births < 39 weeks gestation without medical indication and improving birth registry accuracy project
In 9 months,
improve birth
registry
accuracy so that
focused
variables**
will be transmitted
accurately in
95% of records
(** Pre-pregnancy and
Gestational Diabetes; Pre-
pregnancy and Gestational
hypertension; Induction of
Labor; ANCS;
OB estimate of GA)
Key Drivers Interventions
Aim
IPHIS (BR) fields include
essential and specific
information/definitions
• Identify a key clinical contact for birth data
team
• Identify all sources of birth data
• Identify process for flow of data into the birth
registry (IPHIS) system
• Ensure birth data team has access to
necessary clinical data
• Utilize ODH and OPQC online education
modules for training of birth data and nursing
staff
• Ensure clear understanding of birth registry
variables
• Ensure clear understanding by birth data team
of medical terminology related to birth registry
variables
• Group and individual webinars and
1:1 support by state quality
coordinators to identify key changes
Identification and spread
of best practices for data
entry and verification
Trained clinical and birth
data teams
Audit Process for data
verification
• Coaching/reinforcement by OPQC and state
quality coordinators
• Clarify IPHIS definitions and instructions
Appreciation of the
Importance of the Birth
Registry information
• Use medical record to IPHIS quality review
feedback to identify gaps
• Continuous monitoring of Birth Registry data
reports
Strong communication
between clinical team and
birth data staff
Revised: 1.31.13
Goal
Quarter 3 Data…..
ANCS: June data: 98% July data: 97% August data – 99%
Pre-pregnancy & Gestational Diabetes: June data: 93% July data: 98% August data: 100%
Pre-pregnancy & Gestational Hypertension: June data: 90% July data: 95% August data: 98%
Induction of Labor: June data: 90% July data: 93% August data: 98%
Obstetrical Estimate of Gestation at Delivery: June data: 84% July data: 91% August data: 92%
Month 4 in Review
Wave 2 Learning Session – August 26, 2013
• 19 out of 22 Wave 2 teams in attendance • 5 groups: Birth Abstractors, Nurses, Administrative Staff, QI Specialist, Physician • Wave 2 hospital staff - 57; OPQC & ODH staff - 16; guests – 4
Learning Session Comments:
• “I found sharing and discussing our storyboards was very beneficial. I also appreciated clarification of the data we are collecting and why.”
• “Most engaged with sharing of storyboards & finding out other facilities’ areas of improvement.”
• Allow more time & space for storyboard presentation. Best learning & interaction during that time.”
• “Success stories/strategies. Sharing storyboards - common obstacles/solutions.”
Storyboards are posted on OPQC website Sign in as “Member” Left side bar, click on Presentations > Learning
Sessions > 39-Weeks > Wave 2 > Storyboards
WEBSITE: http://opqc.net
Sign in as “Member” Left side bar, click on
Presentations > Learning Sessions > 39-Weeks > Wave 2 > Storyboards
Sign in as “Member” Left side bar, click on Presentations > Learning Sessions > 39-
Weeks > Wave 2 > Storyboards
Variables of the Month:
Induction & Augmentation
Source: Guide to Completing the Facility Worksheets for the Certificate of Live Birth Ohio Department of Health Office of Vital Statistics, rev. May, 2013. items 22b, 22c
“The focus of healthcare for women and infants over the next century depends on the quality of the data collected by those
who fill out the birth certificates.”
Bill Callaghan, MD MPH Centers for Disease Control and Prevention December 1, 2011
• Augmentation – Stimulation of uterine
contractions by drug or manipulative technique with the intent to reduce the duration of labor
• For this item, labor should have begun before medications were given
• Induction of labor – Initiation of uterine
contractions by medical and/or surgical means for the purpose of delivery before the spontaneous onset of labor
• For this item, medications are given before labor has begun
Induction or Augmentation?
Pt arrives with irregular ctx, 0 station, 60% effaced, 3 cm-changed from 1-2 cm, membranes intact. 37.6 wks GA. Pitocin ordered.
Induction
Augmentation
Induction or Augmentation? Pt arrives at 6am for scheduled induction. Her water broke in the shower at 5am. 38.1 wks GA, no contractions. Pitocin ordered.
Induction
Augmentation
Induction or Augmentation?
Pt presents to the unit at 9pm. She is 38.6 weeks gestation. Bishop score is 5. She is ordered Cervidil® (dinoprostone) 10 mg.
Induction
Augmentation
POLL: Induction or Augmentation?
Pt arrives. 39.0 wks GA. Dilated 1-2 cm, -1 station; no ctx. OB admits her and does AROM-artificial rupture of membranes.
Induction
Augmentation
EMR Usage in Abstraction of Birth Data
• Jane Pierce, CNS, MSN
Upper Valley Medical Center
PDSA sharing
• Lynette DeBertrand
Nurse Manager – the BirthPlace
East Ohio Regional Medical Center
First things first…..
• Is the necessary data being documented in your EMR?
• Is this a standardized process?
(Is the data ALWAYS pulled from the same place by the same person(s)?)
• WHERE is the data being entered into the EMR?
EMR software systems used in our Wave 2 sites
0
1
2
3
4
5
McKesson OBIX Meditech OB TraceVue EPIC GE Centricity paper Cerner Siemens Midas
Nu
mb
er o
f Si
tes
Usi
ng
EMR Systems
Wave 2 EMR Usage
“Birth Certificate Worksheets”
• What have other hospitals done?
– Hospital #1
• Worked with IT and EPIC
– Hospital #2
• Internal IT
• New EMR implementation?
• What challenges have you encountered? How were they overcome?
• What part does your EMR play to assist in birth data abstraction?
Team Discussion
Next Steps…
• Meet as a team and choose a small test of change. Implement one PDSA. Consider “sharing seamlessly” your results on our next call.
• Complete Monthly Progress Report (including your team’s 10 chart review results)
– Link will be sent from ODH-VS this week; DUE 10/10
• Next month’s Action Period Call is 10/21 at 12N
