TexasAIM SETRAC Updates Catherine Eppes, MD, MPH Jeremy Triplett Assistant Professor, Baylor College of Medicine Maternal and Child Health Section Director Faculty Chair, TexasAIM Plus Obstetric Texas Department of State Health Services Hemorrhage Learning Collaborative 1 Southeast Texas Regional Area Council Meeting • September 11, 2019
Introduction to TexasAIM Initiative Goals of TexasAIM 1. Participation from more than 75% of Texas hospitals with OB lines of service (currently 217/225 = 96%) 2. Engage 50% or more participating hospitals in a Learning Collaborative (181/225 = 83%) 3. Support hospitals with tools and technical assistance in quality improvement as they implement bundles 4. Foster partnerships to develop and align infrastructure and resources to support TexasAIM goals 2
Senate Bill 17 85 th Legislature, 1 st Special Session Sec. 34.0156. MATERNAL HEALTH AND SAFETY INITIATIVE. (a) Using existing resources, the department, in collaboration with the task force, shall promote and facilitate the use among health care providers in this state of maternal health and safety informational materials, including tools and procedures related to best practices in maternal health and safety. 3
Reasons for TexasAIM Bundles Obstetric hemorrhage and eclampsia among leading causes • of preventable severe maternal morbidity in Texas Evidence from California and other AIM states shows that • AIM bundles work to reduce severe maternal morbidity Drug overdose, mainly due to opioids, is the leading cause • of pregnancy-associated death in Texas 4
TexasAIM Maternal Safety Bundles Implement AIM Maternal Safety Bundles • Goal: Reduce severe maternal morbidity using evidence-based systems to enhance maternal care • Implementing AIM bundles for: Obstetric hemorrhage Severe hypertension in pregnancy Obstetric care for women with opioid use disorder 5
Purpose (Available in the TexasAIM Plus OBH Information Packet, as part of the OBH Learning Collaborative Charter )
TexasAIM Plus Obstetric Hemorrhage (OBH) Learning Collaborative Aim
TexasAIM Plus Learning Collaborative Faculty Carey Eppes, MD, MPH TexasAIM Faculty Chair Linda Beaverstock, Rakhi Dimino, MD, Kendra Fohl, Karin Fox, MD, M.Ed. Carlos Carreno, MD BSN, RNC-OB, C-EFM MMM, FACOG BSN, RNC-OB Suzanne Lundeen Carol Whittaker, MSN, Patti Heale, Renee’ Jones, DNP, RNC- Jamie Morgan, MD PhD, RNC-OB, NEA-BC RNC-OB, C-EFM DNP, RNC-OB, C-EFM OB, WHNP-BC
11 TexasAIM Ops Team Karen Kendrick Megan Coulter, Ashley Julie Stagg, MSN, RN MPH Steenberger, MSN, RN, THAF DSHS Maternal MPH, CHES IBCLC DSHS VP, Clinical Health & Safety DSHS Maternal Healthy Texas Initiatives Coordinator Health & Safety Mothers & Coordinator Babies Branch Manager Meghan Peel, Manda Hall, PhD Katrina Flores, MD Associate Jeremy Manager, MPH Commissioner, Triplett Surveillance and DSHS MCH Community Director, Data Analytics Senior Health Maternal and Group, Maternal Epidemologist Improvement Child Health & Child Health Division, DSHS Section, DSHS Epidemiology, DSHS
Southeast Texas RAC TexasAIM Participants 1. Ben Taub Hospital (Plus) 20. Houston Methodist West Hospital (Plus) 2. CHI St. Luke's Health–Sugar Land Hospital (Plus) 21. Houston Methodist Willowbrook Hospital (Plus) 3. CHI St. Luke's Health–The Vintage Hospital (Plus) 22. Huntsville Memorial Hospital (Plus) 4. CHI St. Luke's Health–The Woodlands Hospital (Plus) 23. Lyndon Baines Johnson General Hospital (Plus) 5. Children's Memorial Hermann Hospital (Plus) 24. Matagorda Regional Medical Center (Basic) 6. Columbus Community Hospital (Basic) 25. Memorial Hermann Cypress Hospital (Plus) 7. HCA Houston Healthcare- Clearlake (Basic) 26. Memorial Hermann Greater Heights Hospital (Plus) 8. HCA Houston Healthcare- Conroe (Basic) 27. Memorial Hermann Katy Hospital (Plus) 9. HCA Houston Healthcare Cypress Fairbanks (Plus) 28. Memorial Hermann Memorial City Medical Center (Plus) 10. HCA Houston Healthcare Kingwood (Plus) 29. Memorial Hermann Northeast Hospital (Plus) 11. HCA Houston Healthcare- Northwest (Plus) 30. Memorial Hermann Southeast Hospital (Plus) 12. HCA Houston Healthcare Southeast (Plus) 31. Memorial Hermann Southwest Hospital (Plus) 13. HCA Houston Healthcare Tomball (Plus) 32. Memorial Hermann Sugar Land Hospital (Plus) 14. HCA Houston Healthcare West (Plus) 33. Memorial Hermann The Woodlands Medical Center (Plus) 15. Houston Methodist Baytown Hospital (Plus) 34. Oakbend Medical Center (Plus) 16. Houston Methodist Clear Lake Hospital (Plus) 35. St. Joseph Women’s Medical Center (Basic) 17. Houston Methodist Hospital at Texas Medical Center (Basic) 36. Texas Children's Hospital Pavilion for Women (Plus) 18. Houston Methodist Sugar Land Hospital (Plus) 37. The Woman's Hospital of Texas (Plus) 19. Houston Methodist The Woodlands Hospital (Basic) 13
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Assessing Progress Action Period 1
Assessing Progress • Action Period Surveys • Family of Measures • Change Package/Driver Diagram 16
SMM Rate, All Deliveries April-June 2018 5.00% 4.50% 4.40% 4.00% 3.50% 3.00% 2.50% 2.00% 1.60% 1.50% 1.00% 2 zeros 0.50% 0.00% SETRAC Average of Texas Hospitals 50th Percentile Texas Hospital *Missing data excluded Prepared by Maternal and Child Health HTMB Group 5/30/2019
SMM Rate (excluding transfusions) All Deliveries April-June 2018 3.00% 2.70% 2.50% 2.00% 1.50% 1.00% 10 zeros 0.50% 0.50% 0.00% SETRAC Average of Texas Hospitals 50th Percentile Texas Hospital *Missing data excluded Prepared by Maternal and Child Health HTMB Group 5/30/2019
SMM rate among births with obstetric hemorrhage April-June 2018 80.00% 75.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 20.00% 6 zeros 10.00% 0.00% SETRAC Average of Texas Hospitals 50th Percentile Texas Hospital *Missing data excluded Prepared by Maternal and Child Health HTMB Group 5/30/2019
SMM (excluding transfusion) rate among births with obstetric hemorrhage April-June 2018 20.00% 17.60% 18.00% 16.00% 14.00% 12.00% 10.00% 8.00% 6.00% 3.30% 4.00% 2.00% 14 zeros 0.00% SETRAC Average of Texas Hospitals 50th Percentile Texas Hospital *Missing data excluded Prepared by Maternal and Child Health HTMB Group 5/30/2019
Readiness 26
Readiness Components Immediate Access Hemorrhage Cart OB Response Team to Medications 98% 1 32% 2 99% 2 Unit Edu on OBH & on Protocols for nurses Massive Transfusion Protocols/ 86%, 83% 1 Emergency Blood Unit Edu on OBH & Protocols for MDs & CNMs Product Release 32%, 30% 1 Unit Based Drills 69% 1 100% 2 Sources: 1. DSHS, TexasAIM Data Portal, May 24, 2019; 2. DSHS, TexasAIM Action Period Status Update Survey, 5/30/2019.
Action Period Status Update Survey: Established maternal early warning system 100 90 80 70 60 50 41.3 40 35.7 25.0 25.0 30 22.0 17.3 20 10.0 10.7 9.3 10 3.6 0 Fully in place, In place, not Started testing on Started planning, Not started consistently consistently a small scale, but but not fully in implemented implemented not fully in place place SETRAC State *Missing data excluded 32 Prepared by Maternal and Child Health HTMB Group 5/30/2019
Action Period Status Update: SETRAC: Concerns about limited blood supply access 24.1 10.3 65.5 Yes Unsure/Don't Know No *Missing data excluded 33 Prepared by Maternal and Child Health HTMB Group 5/30/2019
Recognition and Prevention 36
Recognition and Prevention Components Assessment of Quantitative Blood Hemorrhage Risk Loss 87% 1 13% 1 Active management of 3 rd Stage of Labor 85-97% across components 2 Sources: 1. DSHS, TexasAIM Data Portal, May 24, 2019; 2. DSHS, TexasAIM Action Period Status Update Survey, 5/30/2019.
Response 40
Response Components Patient and Family Support Unit-standard stage-based Program for hemorrhage event obstetric hemorrhage emergency plan with checklists 0% 2 Policy: 81% 1 Staff Support Program for hemorrhage event Emergency management fully in place: 43% 2 18% 2 Sources: 1. DSHS, TexasAIM Data Portal, May 24, 2019; 2. DSHS, TexasAIM Action Period Status Update Survey, 5/30/2019.
Reporting and Systems Learning 46
Reporting and Systems Learning Components Culture of Huddles Multidisciplinary for High-Risk review of Patients/ Post events/issues Event De-briefs 46% 25% System to measure and monitor outcomes Collecting process measures: 75% Collecting outcome measures: 68% Regularly reviewing metrics with QAPI: 82%
“Ripe” Topics for Collaborative Learning and Accelerated Quality Improvement Sources: Action Period Status Update Survey Learning Session Discussions and Feedback 51
AP Survey: Hospitals want to learn from other hospitals about: 1. Setting up OB code, OB response team, and notification systems 2. Standardized case review and QAPI implementation 3. Implementation and utilization of debriefs 4. Debriefing with families 5. Setting up drills and simulations/unit education 6. Utilization of checklists 7. Patient, family and staff support programs 8. Policies for refusal of blood products 9. Implementation of quantification of blood loss 10.Physician buy-in 11.Developing critical thinking skills for effective response 12.Success stories/lessons learned for all bundle elements 52
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