1. Where We Are And Where We Have Been

2. CollaborativeFocus Perinatal Collaborative Launched in 2007 Initial funding by Dept of Health and Mental Hygiene 30 of 34 Maryland birthing hospitals, touching 90% of births in the state and two DC hospitals and one VA hospital. Aim: reduce infant harm through integration of systems improvements and team behaviors into maternal-fetal care; Create perinatal units that deliver care safely and reliably with zero preventable adverse events.

3. Neonatal Collaborative Launched in 2009 Initial funding by CareFirst BlueCross BlueShield 26 birthing hospitals from MD, DC and VA Aim: improve neonatal outcomes by reducing neonatal morbidity, mortality and cost of care. Includes using standardized resuscitation and stabilization of the neonate in the first hour of life -- the “golden hour” and improving teamwork and communication through use of team behaviors, including the family, in neonatal care

4. Perinatal/Neonatal Learning Network Merged in 2011 Today 30 of 32 Maryland birthing hospitals participate, along with 1 DC hospital and 1 VA hospital. Aim: FY 2014 to improve identification of mothers and infants at risk prior to discharge and increase numbers of referrals and decrease readmissions less than 30 days. In FY 15 identify strategies to reduce maternal mortality from OB hemorrhage and reduce neonatal cases of NEC.

5. Golden Hour Golden Hour MeasuresBaselineQ4 10Goal Axillary Temperature37%7%0% Chronic Lung Disease14.80% 12.2% (18% reduction)10% relative reduction Pulse Oximetry26%57%80% 1-Hour Antibiotics41%62%100% 1-Hour Surfactant93%97%100% Mortality Rate4.84%5.96%*10% relative reduction Average Initial LOS38 days 35 days (7.9% reduction)10% relative reduction * Change not statistically significant using Fisher's Exact Test. P = 0.707134

6. AIMMetricBaseline PeriodQ4 10 Reduce Incidence of HAIs NICU CLABSI Rate2.3/10002.0/1000 Central Line Insertion Compliance80%92% Central Line Maintenance Compliance56%92% Decrease Morbidity and Mortality Incidence of Chronic Lung Disease14.80%12.20% Mortality4.84%5.96%* Decrease Length of StayAverage Initial LOS38 days35 days * Change not statistically significant using Fisher's Exact Test. P = 0.707134 Golden Hour

10. Answer Choices – Responses – –3Rs PowerPoint for staff education 0.00% 0 –Neonatal Risk Assessment Tool 71.43% 5 –Perinatal Risk Assessment Tool 14.29% 1 –DHMH Referral Guidelines Poster 28.57% 2 –None 14.29% 1 Total Respondents: 7 What items in the 3Rs Toolkit have you used? What items in the 3Rs Toolkit have you used? 3Rs Toolkit

11. If you have not used any of the items in the toolkit, why not? Answer Choices –Responses – –I didn't know about the toolkit 0.00% 0 –I forgot about the toolkit 0.00% 0 –I have other priorities 100.00% 2 Total Respondents: 2

12. 3Rs Toolkit I plan to use the following items in the toolkit: Answer Choices –Responses – –3Rs: Risks, Referrals and Readmissions PowerPoint 14.29% 1 –Neonatal Risk Assessment Tool 57.14% 4 –Perinatal Risk Assessment Tool 28.57% 2 –DHMH Referral Guidlines Poster 42.86% 3 –I do not plan to use the toolkit items 28.57% 2 Total Respondents: 7

15. So what now? FY 16 initiatives - expert focus group discussions Your input is critical and welcome How involved would you like to be? Identify funding sources

16. Questions?