Enhancing the Safety of Hospital Transfers from Planned Community-Based Births - PowerPoint Presentation

1. Enhancing the Safety of Hospital Transfers from Planned Community-Based BirthsA Quality Improvement Program at the Foundation for Health Care Quality Hospital NameDate of Presentation

2. DisclosuresThe speakers have no conflicts of interest to disclose

3. Support from:Foundation for Health Care Quality – OB COAPWashington 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 ACNMAmerican Institutes for Research grant

4. Smooth Transitions WorkgroupAudrey Levine, LM – Co-ChairRobin deRegt, MD – Co-Chair Bob Palmer, MD – founding Co-ChairMelissa Denmark, LM, CPM - Program CoordinatorDale Reisner, MD – Swedish Medical CenterAli Lewis, MD – Northwest HospitalMichele Kulhanek – Assistant Director, Maternal-Infant Health Initiatives and Patient Safety at WSHATiffani Buck, MSN, RN – Women’s Health & Perinatal Public Health Nurse Consultant – WA Department of HealthMarie Kaminskis, RN, BSN – Legacy Salmon Creek, VancouverJamie George, CNM – Providence Regional Medical Center, EverettDavia Loren, MD – University of Washington Medical CenterGreg Tryon – EMS representativeRachel Wortman-Morris, PhD - Health Care Consumer/AdvocateBeth Arcese, LM, CPM Frank Andersen, MD, Clinical Education Director, Ob/Gyn, WSULisa Stotts, LM, CPMMembers:

5. Smooth TransitionsMission: 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 protocolsCollect and analyze transfer outcome data for the purpose of quality improvementBuild greater collaboration between community-based midwives, EMS, and hospital care teamEnhance the patient experience of care when transfers occur

6. ACOG Committee OpinionAlthough 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

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8. Intrapartum Transfers from Planned Community-Based BirthsNationally, 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 relief53.2% 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.

9. Postpartum and Newborn Transfers1.5% of mothers were transferred immediately postpartum, primarily for hemorrhage and retained placenta 0.9% of newborns were transferred after birth, primarily for respiratory problemsCheyney, 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.

10. Perinatal Outcomes for Planned Community-Based Birthsde 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

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

12. Licensed Midwives: Landscape in Washington State

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14. Overview of Smooth Transitions ProgramBrief historyPresentations throughout Washington State and nationallySuccessful models of program implementation

15. Getting StartedHost a Smooth Transitions presentation1Identify clinician champions 2Establish a Perinatal Transfer Committee 3Develop/adopt transfer tools4

16. Next StepsPerinatal Transfer Committee meets 2-3x/yearAdopts Best Practice Transfer Guidelines http://www.homebirthsummit.org/wpcontent/uploads/2014/03/HomeBirthSummit_BestPracticeTransferGuidelines.pdfExamines any trends with transfers; what’s working/not workingExplores 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)

17. Taking Quality Improvement to the Next LevelData collection & AnalysisProtected Case Review

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19. Thank You!Melissa DenmarkSmooth Transitions Program Coordinatorsmoothtransitions@qualityhealth.org www.obcoap.org/smooth-transitions-initiative