BCI Webinar A Photo Finish Celebrating Your Success! March 29 th, 2018

Transcription

1 BCI Webinar A Photo Finish Celebrating Your Success! March 29 th, 2018

2 Welcome Please enter your Audio PIN on your phone or we will be unable to un-mute you for discussion If you have a question, please enter it in the Question box or Raise your hand to be unmuted This webinar is being recorded Please provide feedback on our post-webinar survey 2

3 Overview How Far We Have Come Survey Results Sustainability BCI Phase 2 Adjourn 3

4 How Far We Have Come 4

5 BCI Initiative-Wide Average Accuracy of All 22 Birth Certificate Variables 5

6 Accuracy Improvement Across BCI Hospitals 6

7 Most Improved Birth Certificate Variables 7

8 BCI Summary Greatest improvements: o BCI achieved 94% accuracy overall o Hospitals starting with 90% accuracy o Continuous variables o audit variable agreement following webinars suggest increase accuracy reporting vs agreement 8

9 BCI Summary Improvements were likely a result of: o Changes in hospital reporting practices o Monthly webinars on improving reporting accuracy o Training on correct data sources/conversion tools 9

10 on a successful initiative!! You are making a difference in the care of new mothers and babies!!! 10

11 Evaluation Survey Results 11

12 Survey Who completes the BC: Medical record clerks - 50% of hospitals Maternity clerk 20% Nurse 20% Vital Statistics Coordinator/HUC 10% Most hospitals have 1-2 or 5-6 BC clerks 12

13 Survey Quality of all BCI elements was rated as Excellent by at least 50% of participating hospitals BCI elements that led to most change in reporting practices: BCI monthly reports Overall initiative Webinar presentations 13

14 Survey Most hospitals agreed that the BCI webinar presentations: Were easy to attend and understand Provided useful information and covered relevant topics Time and duration were appropriate All hospitals were satisfied with their monthly BCI reports 14

15 Survey Following the completion of the BCI: At least 75% of all hospitals were likely to continue the efforts in improving BC reporting accuracy 15

16 Survey Changes hospitals made in BC reporting as a result of participating in the BCI: Who and when the worksheets were completed How birth clerks search the medical record vs asking the mother Consistency in entering all weight Dissemination & clarity of variables to clerks 16

17 Survey Challenges experienced in making these changes or trying to make changes: Having L&D nurses correctly complete birth worksheets which BC clerks use to fill out BC Use of birth worksheet (may not capture all data) by clerks due to high volume BC to be processed Getting used to the process 17

18 Survey Challenges (cont d): Staff s inconsistency with filing or obtaining most recent records Lack of management participation to implement changes for improvement Limited time to do a thorough audit 18

19 Survey Most helpful BCI aspects for improving birth certificate reporting in your hospital: Having support from other hospitals and FPQC Clarification on the key variables in webinars/guide Realizing inaccurately reported data and areas for improvement 19

20 Survey Changes recommended for when we expand initiative to other hospitals: Meeting with management to stress importance of audits and BC registration Ensuring audits are completed by clinical lead and not BC clerk Adding field for medical record # on Vital Statistics PQ Control Form 20

21 Survey Changes recommended (cont d): Ensuring all hospitals follow set guidelines Focused item for improvement each month and tips to overcome resistance Ensuring timely BC samples on 1 st of each month 21

22 Survey BCI rating relative to other data reporting initiatives participated in: Very good to Excellent (3 respondents missing) 22

23 Sustainability 23

24 Evaluation one year after improvement initiatives ended showed ~33%: Improvement projects reverted to previous ways Maintained improvement but was not adopted by others in organization Maintained gain and there was evidence of adoption outside core change area NHS Institute for Innovation and Improvement

25 Suggestions Sustain organizational and system changes that led to improvements Continue to train new staff 25

26 Your thoughts about sustainability? 26

27 BCI 2 nd Round For New Hospitals 27

28 Variables to Keep 1. Birth weight 2. Total number of prenatal visits 3. Prepregnancy weight 4. Weight at delivery 5. Previous preterm birth 6. Induction of labor 7. Augmentation of labor 8. Antenatal corticosteroids 9. Antibiotics received by the mother during labor 10. Obstetric Estimate of Gestation 11. Breastfeeding at discharge 12. Assisted ventilation required immediately following delivery 13. Assisted ventilation required for 30 minutes 14. Assisted ventilation required for 6 hours 28

29 Variables to Potentially Keep 1. Prepregnancy diabetes 2. Gestational diabetes 3. Pre-pregnancy or chronic hypertension 4. Gestational hypertension 5. Hypertension-eclampsia 29

30 Variables to Potentially Drop 1. Fetal intolerance of labor 2. Maternal transfusion 3. NICU Admission 30

31 Variables to Add 1. APGAR 2. Fetal presentation at birth (Cephalic) 3. Final Route of and Mode of Delivery (C/S) 4. Month Prenatal Visit Began 31

32 Your thoughts and recommendations? 32

33 Neel Shah, MD, MPP Reducing Cesarean Sections Heather Kaplan, MD Neonatal Abstinence Syndrome Tara Bristol Rouse, MA Engaging Families in Quality Improvement Ann Borders, MD Optimizing Physician Engagement in QI Karen Harris, MD Shared Decision Making 33

34 Thank you! 34