Becker's Clinical Quality & Infection Control

31 QUALITY IMPROVEMENT & MEASUREMENT Viewpoint: How whiteboards could help hospitals cut C-section rates By Mackenzie Bean I mproved communication may be the missing piece of the puzzle for hospitals trying to lower their cesarean-section rates, journalist Allison Yarrow wrote in an op-ed for e New York Times. In 2017, 32 percent of live births involved C-sections, according to the CDC. is figure more than doubles the World Health Organization's recommended range of 10 to 15 percent. Many hospitals have implemented quality initiatives to lower their C-section rates and only see modest improvements, according to Ms. Yarrow. She cited Over- lake Medical Center as an example. e Bellevue, Wash.-based hospital's C-sec- tion rate has stayed around 30 percent since 2014, despite the hospital applying evidence-based best practices to reduce it. Now, the hospital is taking a new ap- proach using a simple tool: whiteboards. Ms. Yarrow said every labor and delivery room in the hospital contains a large whiteboard in which the care team writes down four things: • e name of every team member • e patient's birthing preferences • e status of the patient, baby and labor process • A time for when the whole care team and patient will reconvene e whiteboards are meant to keep moth- ers more informed at every stage of labor, which could help reduce C-section rates, according to Ms. Yarrow. Overlake is one of four community hospi- tals investigating the use of whiteboards in a clinical trial set to end this year. Prelim- inary results show the strategy is proving effective at decreasing C-sections. n Centers of excellence not linked to lower mortality, readmission rates By Mackenzie Bean H ospitals designated as centers of excellence do not always achieve bet- ter patient outcomes, suggest the findings of a study published in JAMA Internal Medicine. For the study, researchers from Philadelphia-based Penn Medicine examined mortality and readmission rates for 62 New York hospitals performing percuta- neous coronary interventions in 2015. Half of the hospitals were designated as centers of excellence through one of the following programs: • Aetna's Institutes of Quality for cardiac medical interventions — five hospitals • Cigna's Centers of Excellence for cardiac catheterization and angioplasty — nine hospitals • Blue Cross Blue Shield's Blue Distinction Centers for cardiac care — 17 hospitals Cigna- and BCBS-designated centers of excellence did not show any differenc- es in risk-standardized 30-day mortality rates after a PCI when compared to oth- er hospitals. Aetna-designated hospitals had a higher average 30-day mortality rate after a PCI (1.4 deaths per 100 cases) compared to undesignated hospitals (1.1 deaths per 100 cases). In addition, average 30-day readmission rates after a PCI did not differ between centers of excellence and other facilities. Researchers suggested payers may be assigning center of excellence designa- tions based on cost or other nonclinical factors. They said more work must be done to improve criteria to better identify which hospitals outperform peers. n How this Georgia hospital is addressing high maternal mortality rates By Mackenzie Bean G eorgia has the highest maternal mortality rate of all states at 46.2 deaths per 1,000 births, but Lawrenceville, Ga.-based Gwinnett Medical Center is working to change that, reported the Gwinnett Daily Post. The hospital, which houses a level 3 neonatal intensive care unit, is participat- ing in two initiatives to help lower postpartum hemorrhage rates: The Georgia Perinatal Quality Collaborative, and the The Association of Women's Health, Obstetric and Neonatal Nurses Postpartum Hemorrhage Project. In the second quarter of 2018, 6.7 percent of GMC patients who experienced postpartum hemorrhaging had a severe maternal morbidity event, which fell to 5.8 percent in the third quarter of 2018. For reference, 24.2 percent of women at other hospitals with level 3 NICUs par- ticipating in the Georgia Perinatal Quality Collaborative experienced a maternal morbidity event after a postpartum hemorrhage. "In-house drills, assessments of processes and procedures, and collaboration have been key," Veritta Henderson, RN, a perinatal practice specialist at GMC, told the Gwinnett Daily Post. "Furthermore, leadership and medical providers are extremely open to new findings and supportive of a team approach." n

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