PQCNC SIVB2 LS2 Keys to High Performing Teams

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WhoisVidantHealth?

VidantHealthSystemsisanetworkof10hospitalsacrosseasternNorthCarolina

VidantMedicalCenter(formerlyPi@CountyMemorialHospital)- 861licensedbeds- AffiliatedwithEastCarolinaUniversityBrodySchool

ofMedicine

- Theregionalteraryreferralcenterfor29counesineasternNC

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WomensServicesatVMC

ProvidelowriskObstetricandhigh-risk

Maternal-FetalMedicineservices

Approximately3800deliveriesannually

Environment:- 11LDRPs- 12LaborRooms - 4OperangRooms- 2bedPACU- 3bedTriage- 12bedAntepartumUnit- 28bedMother/BabyUnit- 16bedConvalescentNewbornNursery- 50bedNICU

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VidantChildrensHospitalSummer2013

OpeningnewChildrensHospital

Summer2013

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OurProviders

ECUBrodySchoolofMedicine Maternal-FetalMedicineSpecialists Ob/GynPhysicians CNMs

Pediatricians Neonatologists NeonatalNursePraccioners FamilyMedicinePhysicians FamilyNursePraconers PediatricSubspecialistssuchassurgery,urology,

oncology,etc

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- Privatepraccecommunity Obstetricians Pediatricians CNMs FamilyNursePraconers

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WomensServicesPrograms

- LactaonConsultants7daysaweek- MaternalExpressionsBreaseedingBouque

- OutpaentLactaonSpecialistsconsultaons

- BreaseedingSupportGroup- PerinatalandNeonatalOutreach

- HopefulBeginningsPostpartumSupportProgram

- VolunteerDoulaProgram

- Classesandtours

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Someachievements

FamilyCenteredMaternity-NewbornCare

(mother/babycoupletcaremodel)

BantheBagsAward-2009

BreaseedingFriendlyWorkplaceAward-2011

LactaonCareAward-2011

ReceivedBabyFriendlyHospitaldesignaon-December,2011

NCMaternityCenterBreaseedingFriendlydesignaon-

December,2011

InvolvementwithPQCNC-NICUandWomensServices

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SIVBTeamMembers

ElaineClark,PerinatalClinicalNurseSpecialist Dr.JimdeVente,ObMedicalDirector

DawnArnold,L&DInformacsRN

KimberlyHarper,PerinatalOutreach

MicheleMusella,L&DManager

AngelaSll,Administrator

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Wheredowestart?

- 39weeksiniavewasmucheasier- SupportforIntendedVaginalBirth

notsomuch!

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Takealookinthemirror

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Clinicalcourage

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TeamMeengs

InialTeammeeng TeamparcipatesinSIVBWebinarstogether A@endSIVBLearningSessionstogether

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PracceChanges

LaborSupport- PrivatepracceDoulas

- ImplementedavolunteerDoulaprogramonweekends,DOVE

- Doulasprovidedinformaonatourskillsday

- Encourageduseofbirthingballandhydrotherapy- L&DManagerhasaPhDinIntegraveMedicine

andusesrelaxaon,Reiki,andaromatherapywith

paents

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- Purchasedremotefetalmonitorequipmenttoincreaseambulaoninlabor

- ImplemenngAWHONNPerinatalStaffingGuidelinestoareatthebedside

- Useofpeanutballforpaentswithepidurals

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ThePeanutBall?

BannerGoodSamaritanMedicalCenter,Phoenix

- Paentswithepiduralswhousedthepeanutballdecreasedthefirststageoflaborbyalmost90minutesandthesecondstageby23minuteswhen

comparedtothecontrolgroup

- C-seconratewas13%lessforthepaentswithepiduralswhousedthepeanutballcomparedtothosewhodidnot

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InduconofLabor

ChangedtheInduconofLaborGuidelinefornulliparouspaentsto40-41weeksgestaon

DistributedPQCNCposterstoproviderofficesandplacedinTriage

Providedtalkingpointsforprenatalproviderssuchas:- Ifptisatleast4cmdilatedonadmissiontoL&D,thereisa

1in10chanceofaC-secon

- Ifaptisinducedthereisa1in3chanceofaC-secon

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DataEntryandDistribuon

ElectronicBirthLog- DawnArnoldentersdatafor40chartspermonth- Eitherusefirst15daysofthemonthorlast15daysofthe

month

Dataisshared- ObExecuveCommi@ee- Ob/GynDeptMeengs- Staffmeengs- VidantHealthWomensClinicalIntegraon- PerinatalOutreach

P t d i@ d i l b

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Paentsadmi@edinlaboraverage46%(130of285)

O ll C t

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OverallC-seconrateaverage-22%(63of285)

C t f t d i@ d i l b

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C-seconrateofptsadmi@edinlaboraverage-10%(13of130)

C t f t d i@ d t i l b

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C-seconrateofpaentsadmi@ednotinlaboraverage-32%(49of155)

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PrimaryindicaonforC-secon

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OverallC-seconrateandpayor

C-Section Rates Overall and By Payor

0

5

10

15

20

25

30

35

40

45

Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12

SampleSize

0%

10%

20%

30%

40%

50%

60%

Rates

Sample (N=285)

All Payors (n=62)

Private (n=20)

Other (n=13)

Medicaid (n=29)

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NextSteps

- Researchstudyusing

PeanutBall

- EncourageuseofDOVEprogram

- ConnuepursuitofmeengAWHONN

staffingguidelines

- Monitorinducons- Connueevaluaonofdata