Premier Hospitals are best known in health policy circles for their innovative and successful Pay-for-Performance initiative, as well as winning a Baldrige Award in 2006. This week they unveiled a new program aimed at eliminating preventable birth injuries at 16 participating hospitals.

According to their presentation, three birth-related injuries occur per 1,000 deliveries, and most of the time the specific causes can be identified. Participating hospitals will implement a 21-month collaborative using care bundles (more on that below), identify best practices and measure the cost and quality associated with those practices, and share outcomes to help other hospitals improve. It runs from April 2008 to December 2009.

Approximately 115,000 babies will be delivered at these six hospitals during the nearly two-year program; that means as many as 345 injuries could be prevented, including birth asphyxia (little or no breathing by the infant), cerebral palsy, permanent disability, and death.

The slides from the presentation state that five occurrences are responsible for most adverse perinatal events:

• Failure to recognize fetal distress
• Failure to proceed with a timely cesarean birth
• Failure to properly resuscitate an unresponsive baby
• Inappropriate use of labor-inducing drugs
• Inappropriate use of vacuum/forceps

The 16 hospitals will begin by implementing the following three care bundles; each bundle has four or five required steps (steps can be skipped only for specific medical reasons). The bundles were developed by Premier, the Institute for Healthcare Improvement, and Ascension Health (two are described in detail in this paper):

• Elective Induction Bundle—Four steps to determine whether it is safe for mother and baby to have labor induced via medication

• Augmentation Induction Bundle—Four steps to determine whether it is safe for mother and baby to increase the frequency and strength of contractions via medication

• Vacuum/Forceps Bundle—Five steps to determine whether it is safe for mother and baby to have delivery assisted via vacuum extractor or forceps

The participating hospitals are also using certain teamwork and communication tools to help implement the three bundles.

Frank Perez, CEO of Kettering Health Network, was on hand to discuss their work in recent years implementing the bundles at Kettering Medical Center. He said that by posting bundle-completion data by physician name in the hospital (unblinded!), compliance went from 40 percent to 90 percent in just one year. Nothing like a little peer pressure.

Amy Hailey, a certified registered nurse and Director of Women's Services at both Texas Health Harris Methodist Fort Worth Hospital and Texas Health Presbyterian Hospital of Dallas, was on hand to discuss their involvement at 2 of the 16 hospitals. Dr. Hal C. Lawrence, III from the American College of Obstetricians and Gynecologists shared the dangers of late preterm deliveries (35 to 37 weeks gestation) that are not medically necessary, including higher incidences of sudden infant death syndrome and learning disabilities.

USA Today writes this morning on the project here.  We look forward to the results of this collaborative, and we'll be sure to post related news as it becomes available.