Slide 1

AHA/HRET HEN: Data and Coaching Webinar: Early Elective Deliveries Data Review June 7, 2012 1:00 2:00 PM, CDT

Slide 2

Welcome and Overview Welcome, thank you for joining us today! Housekeeping: This webinar is being recorded and will be archived. You will receive a PDF of todays presentation, later this week, as well as a link to fill-out the evaluation, a summary of Q&A and a link for the recording. For questions: please reach out to your state lead or email us: HEN@aha.org.HEN@aha.org Agenda: EED Measures Content Review Hospital Story Teach Back 2

Slide 3

Polling Questions (#1 and #2) How Many of You are Joining Us From: Hospital type? A. General Medical / Surgical B. Teaching C. Rural D. Childrens E. Long-term Care F. Psychiatric Hospital size? A. CAH B. Not CAH,

Engagement of Providers and Patients Framing: Data is clear about baby risks: 37-38wks >> risk than 41-42 weeks Get local Neonatologists involved, +local data Medical/Obstetric leader(s) a must Senior Administrator leadership is KEY! Hospital policy on EED is a good crutch for practicing OBs Patient education materials/consents/MOD

Slide 31

Steps for QI Make the caseinvolve Pediatrics early How many 37/38 weekers are transferred to the NICU? Collect baseline data Joint Commission measure specifications Work-out collection issues 3 distinct QI sub-projects Documentation Coding Practice

Slide 32

How Do You Measure Elective Deliveries

First Steps (Fundamentals) Gather baseline data of 39 weeks

Slide 34

ACOG Checklist New ACOG form (November 2011) To be revised locally, modeled after many in current use Need to ensure that the indication is well charted

Slide 35

Reference Guide Used in Doctors offices when scheduling cases To be revised locally, modeled after many in current use

Slide 36

Example QI Worksheet Note: OFIs can be used for OPPE for re-credentialling

Slide 37

Questions?

Slide 38

OB/EED Data Management Strategy Charisse Coulombe Data Director, HRET

Slide 39

Why is OB/EED Data Needed? Measures are used to assess the impact of changes To demonstrate hospitals have reduced their rates of harm over the 2 year period To monitor that interventions to reduce OB Adverse Events/Early Elective Deliveries are working Part of the PDSA cycle

Slide 40

What OB/EED Data is Needed? At a minimum, 1 process measure and 1 outcome measure Process: Measures interactions between healthcare practitioner and patient; a series of actions, changes, or functions bringing about a result Outcome: measures change or the end result of healthcare intervention

Slide 41

Encyclopedia of Measures Technical manual to ensure the hospital's measure definitions align with the comprehensive data system (CDS) Comprehensive details about measure characteristics Topic Measure Name Definition Numerator, Denominator Calculation specifications Source(s)

Slide 42

OB/EED Process Measures Elective Deliveries at >=37 Weeks and = 37 and < 39 weeks of gestation completed Antenatal Steroids (JC PC 3) Patients at risk of preterm delivery at 24-32 weeks gestation receiving antenatal steroids prior to delivering preterm newborns DVT Prophylaxis - C-Section (OB)

Slide 43

Early Elective Deliveries The Joint Commission Definition Patients with elective vaginal deliveries or c- sections at >=37 and

Slide 44

Early Elective Deliveries The Joint Commission Definition Denominator: Patients delivering newborns with >= 37 and < 39 weeks of gestation completed Excludes Patients with ICD-9-CM Principal Diagnosis Code or ICD-9- CM Other Diagnosis Codes for conditions possibly justifying elective delivery prior to 39 weeks gestation as defined in Appendix A, Table 11.07 E.g. Preeclampsia, eclampsia, hypertension, twin/triplets, amniotic infection, fetal distress, stillborns Less than 8 years of age Greater than or equal to 65 years of age Length of stay > 120 days Enrolled in clinical trials

Slide 45

Polling Question #1 Has your hospital selected your OB/EED process measure? A. Yes, selected and actively tracking B. Yes, the measure has been selected C. No, still researching which measure to select

Slide 46

OB/EED Outcome Measures C-Section Delivery Rate (JC PC 2) Elective =37 week through

Womens Services: > 2400 Deliveries Annually 10 LDRs 2 NST Clinic Rooms 5 ORs Day Surgery & PACU 26 Bed Post Partum Unit Well Baby Nursery Level III Regional NICU 24 hr NICU Transport Team

Slide 77

Team Rapides

Slide 78

If you cant measure it, you cant manage it. unknown

Slide 79

Add Text Subtitle Add Text, Graph, Picture Blinded Provider Numbers

Slide 80

DHH Birth Outcomes Initiative March of Dimes Toolkit Birthing Centers of Excellence Institute for Healthcare Improvement: Reliable Design Data Measures Elective delivery rate prior to 39 weeks (TJC PC.01) Gestational Age Reliability Cases between elective deliveries < 39 weeks Cesarean Rate for low risk first birth women (TJC PC.02) Transfer to higher level of care

Slide 81

2011 Key Strategies Decrease process variability (Hard Stop Policy, admits, orders, standardized documentation of indications) Dedicated Admissions Nurse Continued data sharing with staff and physicians Tying process improvement to outcomes Education, Education, Education, Education

Slide 82

Slide 83

Blinded Provider Numbers

Slide 84

Elective Delivery Rate prior to 39 weeks (TJC PC.01) % pts electively delivered newborns >= 37 and < 39 wks of gestation completed

Slide 85

Slide 86

Polling Question #3 Regarding physician champions: A.The leader is engaged an dis slowly engaging others. B.The leader is engaged but cant seem to engage others. C.One of the OBs is engaged but is not a leader and isnt getting much traction. D.No OBs are engaged.

Slide 87

87 Questions? 87 ?

Slide 88

Wrap Up and Next Steps Next TOC Reminder: Visit the HRET HEN website: http://www.hret-hen.org/http://www.hret-hen.org/ for information, resources and events, such as the additional topic-specific Data and Coaching webinars throughout June and July. Thank you for joining us! 88