Improving Obstetrical Outcomes & Decreasing Hospital Risk

This blog is taken from a recent HealthStream webinar entitled “Improving Obstetrical Outcomes and Decreasing Hospital Risk.” The webinar was moderated by HealthStream’s Allison Keys and featured HealthStream’s Shelby Bluthardt, Clinical Programs, Solution Executive, Child and Maternal Health and Tanesha Riley, MS, RNC-OB, CCE, Clinical Programs, Solution Executive, Child and Maternal Health. 

The webinar panel presented HealthStream’s Quality OB Program – a solution that has helped users achieve a 22% decrease in negative events when compared to the national average.

OB Care – The Current State in the U.S.

Riley began by sharing the dismal statistics on the U.S.’s maternal health metrics and offered insights on where healthcare organizations should focus improvement efforts.

• There are 32.9 maternal deaths per 100,000 live births or 1,205 maternal deaths each year. That number is worse than the 2019 rate of 20.1 deaths per 100,000 live births indicating that the situation is worsening.
• The news is worse for Black women as there are 69.9 deaths per 100,000 live births as opposed to the 26.6 deaths for White women.
• 74% of OB claims are related to a lack of clinical judgement.
• 34% of maternal deaths and injuries are due to inadequate monitoring.

Riley further shared that the U.S. currently ranks 55^th of 183 countries in maternal mortality.

Improvement Strategies – Where to Focus

Riley pointed out the typical causes of maternal deaths – hypertensive disorders of pregnancy, infection and postpartum hemorrhage, but also added that there were some trending causes of maternal morbidity and mortality including such conditions as substance abuse disorder and suicide.

With these factors in mind, HealthStream has partnered with MedStar SiTEL to provide a data and competency-driven solution to address these challenges.

Knowledge and Competency – Driving Improvement in Maternal Health Outcomes

Maternal health metrics have simply failed to improve (and have actually worsened) when the only solution was to simply provide more training. HealthStream and MedStar SiTEL have worked together to develop a solution that incorporates assessment, learning, case-based sims, testing, application, performance and analytics to drive improvement. Bluthardt and Riley shared some key components that improve confidence and competence in OB nurses.

• Right-sized Learning – Cognitive Load Theory (CLT) suggests that instructional methods be designed in ways that ensure that learners are not over-loaded with information in order to maximize learning. This approach promotes the highest level of retention.
• Knowledge and Competency – High-impact virtual simulations help lead a learner through a clinical scenario providing that learner with an opportunity to apply critical thinking and receive a competency score at the conclusion of the exercise. The analytics feature can then help identify learning gaps and bring awareness to the learner leading to insights that can change behavior and clinical practice.
• Focus on Communication – The Joint Commission has cited communication errors as being the number one cause of sentinel events. The Quality OB Program focuses not just on communication amongst a multi-disciplinary team, but also on communication with patients and families and helps identify barriers to effective communication.
• Effective Documentation – Accurate documentation is essential, particularly when it is important to demonstrate that staff have done the right things in an emergency. Obstetrical documentation with a focus on shoulder dystocia, hemorrhage, and QBL is a key feature of the Quality OB Program. Patient safety checklists help ensure that documentation is full, complete, and correct.
• Data Analytics – The Quality OB Program has built-in analytics that help users better understand the extent to which the education has been effective and identify the need for additional professional development. The reporting can be generated at the organization, facility, department or individual level.
• Reduced Time to Competence – Adaptive learning helps to ensure that the journey to competence is both effective and efficient with assessments that will give them credit for the information that they already know and allow them to focus on other material.

HealthStream’s Quality OB Program – The Results

HealthStream customers have reported some impressive results as the Quality OB Program appears to have had a significant impact on maternal health outcomes. MedStar, an early adopter reported some impressive results within two years of implementing the program. They had zero serious OB safety events and also reported zero shoulder dystocia lawsuits which resulted in an estimated 100% decrease in paid claims based on their average number of claims and associated costs each year, which in turn, resulted in tens of millions in savings annually.

Women’s Hospital in Louisiana reported a different kind of success – improved staff engagement and buy-in. Leaders and employees appreciated the engaging content and evidence-based topics that are regularly updated to align with the latest standards of care.