Illinois has a regionalized perinatal system with ten networks. The Statewide Quality Council establishes quality initiatives that are to be instituted within each birthing hospital. Each perinatal network coordinates these initiatives for member hospitals through the Regional Quality Council (RQC). Two recent evidence-based initiatives are reduction of early elective deliveries (between 37-38 6/7 weeks gestation) and the evidence-based breastfeeding initiative. The Co-Perinatal Center is unique among the ten networks as the Chair of the Committee is a Nursing Leader from a community Level III hospital with expert qualifications including a Doctorate in Nursing Practice.
Baseline data collected by our Network RQC for these two key perinatal measures (early elective deliveries and breastfeeding) demonstrated that improvement was needed.
- Improve outcomes for women & infants cared for in Perinatal network hospitals
- Collaborate with network hospitals on improvement strategies
- Meet state quality improvement requirements
American Academy of Pediatrics. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), pp. e827-e841, doi: 10.1542/peds.2011-3552
Baby-Friendly USA. (2012). Ten steps to successful breastfeeding. Retrieved from http://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative/the-ten-steps
Illinois breastfeeding blueprint. (n.d). Retrieved from http://www.ilbreastfeedingblueprint.org/pages/home/1.php
Institute for Healthcare Improvement. (2012, December 4). How to improve. Retrieved from:http://www.ihi.org/knowledge/Pages/HowtoImprove/default.aspx
Janakiraman, V. & Ecker, J. (2010). Quality in obstetric care: Measuring what matters. Obstetrics & Gynecology, 116(3), 728-732.
World Health Organization. (2014). Breastfeeding. Retrieved from http://www.who.int/topics/breastfeeding/en/
The Institute of Healthcare Improvement methodology of plan-do-study-act was the framework for change. Initial steps included process measures for each initiative, such as policy development. Hospitals were required to demonstrate that these policies were established within the organization. Quantitative data collection tools were developed by the RQC chair and the Perinatal Center for use by each hospital within the Network. Data was submitted to the network administrator and the RQC chair. Aggregate data is shared with all hospitals.
Engagement of hospital administration was the first step for each hospital’s improvement project. The hospitals then developed teams to implement both of these initiatives. The perinatal network assisted and monitored progress for each hospital. Barriers and challenges, as well as successes, were presented to and shared amongst the network hospitals. Project data was submitted to the Perinatal Center, summarized and analyzed by the chair of the network quality council. Aggregated data is shared with all hospitals.
The network has met or exceeded state established goals for each project. All hospitals have
< 5% early elective delivery rate. Hospitals also have implanted the evidence-based breastfeeding initiative. The network breastfeeding initiation rate exceeds the state average. Several hospitals are now on the Baby-Friendly pathway.
Conclusion/ Implications for nursing practice
Implementation of quality or evidence-based projects can successfully be implemented with the perinatal network structure. By networking with other hospitals, improvements can be made. Learning can be implemented and barriers can be overcome. Establishing these as statewide quality projects adds credence to the importance of the work, and compliance with such initiatives.