STUDY: Michigan Hospitals Deliver Healthier Newborns

Sam Watson, Michigan Health & Hospital Association

According to a study recently released in The Joint Commission Journal on Quality and Patient Safety, Michigan hospitals voluntarily participating in the MHA Keystone: Obstetrics collaborative introduced and sustained labor and delivery best practices that protect the health of newborns and improved safety culture among clinical teams. Such an effort requires adherence to evidence-based guidelines, while moving away from informal practices that have developed nationally in recent decades to accommodate scheduling conveniences for families and clinicians.

The study, “Michigan Health & Hospital Association Keystone Obstetrics: A Statewide Collaborative for Perinatal Patient Safety in Michigan,” revealed that, from January through November 2009, Michigan hospitals:

  • reduced elective labor inductions before 39 weeks by 62 percent
  • reduced elective cesarean births before 39 weeks by 68 percent
  • improved five-minute Apgar scores* by more than 51 percent
  • increased compliance with all aspects of induction care by 114 percent including assuring that medication orders are standardized and there is appropriate fetal monitoring
  • increased compliance with all aspects of labor augmentation care by 92 percent including  assuring that medication orders are standardized and there is appropriate fetal monitoring
  • increased perfect scores on identifying and treating indeterminate or abnormal fetal heart rate patterns in a timely and appropriate manner by 81 percent
  • increased compliance with all aspects of care during the second-stage of labor by 98 percent

In addition, participating hospital physicians, nurses and other health care workers that are on the labor and delivery unit experienced a 15 percent increase in job satisfaction, 44 percent increase in working conditions and 50 percent increase in perceptions of hospital management as a result of their efforts. Culture is a major focus because it is the set of shared attitudes, values, goals and practices that characterize an organization/unit/clinical area. A healthy patient safety culture can be the basis for changed practices and sustained improvement over time.

Fifteen hospitals with perinatal services that have participated in MHA Keystone: Obstetrics since its inception were selected for the study. The hospitals were located in rural, midsized and urban areas serving diverse patient populations with a variety of payer mixes and included academic and community hospitals to ensure a representative sample of Michigan hospitals.

*Apgar scores are the result of a test to determine a newborn’s physical health based on appearance, pulse, reflexes, muscle tone and breathing.

About MHA Keystone: Obstetrics

Michigan hospitals deliver more than 117,000 babies every year. Research indicates that there are three injuries and five deaths for every 1,000 births in the United States. In 2008, the MHA determined that these outcomes, some of which are preventable, represented a critically important patient safety improvement opportunity for Michigan hospitals. The resulting initiative, MHA Keystone: Obstetrics, focuses on eliminating preventable fetal and maternal harm due to complications of labor induction and management of the second stage of labor. The collaborative also aligns with Gov. Rick Snyder’s “dashboard” priority to reduce infant mortality. In all, 65 hospitals currently participate in MHA Keystone: Obstetrics.

This guest post is by Sam R. Watson, senior vice president, Patient Safety and Quality at the Michigan Health & Hospital Association and executive director of the MHA Keystone Center for Patient Safety & Quality.

Photo credit: Bart Heird

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