IHI Idealized Design of Perinatal Care IHI Innovation Series 2005 A Deliberate design methodology for Perinatal Care

Idealized Design Bundles  Experts identified processes that will decrease the risk of birth trauma and other adverse events.  Two clinical processes identified for first round – to decrease the incidence of common problems (determined from evaluation of chart review and claims  Based on reliable science and provide common language for team members

BUNDLES  A group of evidence based interventions related to a care process that when executed together result in better outcomes than when implemented individually.  Perinatal strategy based on proven success of the Ventilator Bundle to decrease incidence of VAP

Elective Induction Bundle  Assessment of Gestational Age – ensuring gestational age > 39 wks  Reassuring Fetal Status – assess via NICHD criteria and document  Pelvic Examination – cervical exam, station, presenting part, cervical position and consistency, Bishop’s score, pelvimetry, and fetal presentation  Absence of Hyperstimulation (Tachysystole) during the induction process

ACOG Criteria for Gestational Age Determination (>39 wks)  FHT documented for 20 wks (nonelectronic fetoscope) or 30 wks Doppler  36 wks since + serum or urine HCG by a reliable lab  US measurement of C-R length (at 6- 12wks) support GA of at least 36 wks  US obtained at 13 – 20 wks confirms GA of at least 39 wks determined by clinical hx and physical exam

Augmentation Bundle  Estimated fetal weight – determine size to determine whether continued attempt at vag delivery appropriate  Reassuring fetal status  Pelvic Assessment  Monitoring and managing tachysystole

Road to Success  Leadership – hospital and physician – support and expectations  Adoption of ALL elements of the bundles  All team members committed to follow bundle criteria  Good team work and communication  Standardization of management approaches (i.e. tachysystole)