Those early efforts caught the attention of the Michigan Health and Hospitals Association. The association had achieved dramatic results reducing central-line associated bloodstream infections and ventilator-associated pneumonia, and it was looking to tackle other patient-safety issues.
In 2009, the association launched MHA Keystone: Obstetrics, a 15-hospital pilot aimed at promoting perinatal safety practices and improving outcomes for mothers and babies. The participating hospitals, including Oakwood, were provided with educational tools and received regular feedback. Over the course of the yearlong program, elective inductions fell 62% and elective C-sections dropped 68%, according to results published in the Joint Commission Journal on Quality and Patient Safety.
The program since has been expanded to include 65 Michigan hospitals, accounting for 80% of all births statewide, said Sam Watson, the hospital association's senior vice president who heads the MHA Keystone Center for Patient Safety and Quality. Hospitals have reduced early elective deliveries by 68%, from 4.75% in 2010 to 1.53% in 2012, and neonatal ICU admissions fell 35%. Watson credits the project's success to the use of evidence-based practices and to culture change among clinical staff.
Practices like hard-stops for early deliveries and appropriate use of the labor-inducing drug pitocin are now standard at Oakwood, Cash said. “The medical staff understands what they can and can't do,” he said. “It's evidence-based care—it's as simple as that.”
The number of early elective labor inductions across Oakwood Healthcare's hospitals fell from three in 2009 to zero for 2010, 2011 and 2012. There have been no early elective C-sections since 2011, said Nancy Gray, Oakwood's administrator of women's services.
Watson praised the work of Cash and others at Oakwood. “They were a strong voice in encouraging their colleagues, and they set the example of that desire to seek improvement,” he said.
Follow Maureen McKinney on Twitter: @MHMMcKinney