Perinatal program lowers annual claims 39%

Initial results from one of the nation’s largest and most sophisticated perinatal improvement initiatives suggest hospitals can reduce harm to babies and mothers, and lower associated liability claims and pay-outs, through the use of high-reliability perinatal teams.

Results from Phase 1 (2008-2010) of the Premier Perinatal Safety Initiative (PPSI), a Premier healthcare alliance project, show that the 14 participating hospitals have reduced harm and liability since the program’s baseline period (2006-2007).

In relation to harm, PPSI hospitals have reduced, on average:

  • birth hypoxia and asphyxia, which can cause infant brain damage, by 25%;
  • neonatal birth trauma, which can range from minor bruising to nerve or brain damage, by 22%. In addition, all hospitals were below the 2008 AHRQ Provider Rate, a national comparative rate measuring perinatal harm;
  • complications from administrating anesthesia during labor/delivery, which include cardiac arrest and other cardiac complications, by 15%;
  • postpartum hemorrhage, the most common cause of perinatal maternal death in the developed world, by 5.4%;
  • the adverse outcome index rate, which measures the number of patients with one or more of the identified adverse events as a proportion of total deliveries, by 7.5%;
  • Because of these improvements, approximately 110 fewer mothers and babies experienced these harms.

In addition, participants decreased the number of annual liability claims filed per delivery by 39% vs. 10% at non-participating hospitals. And whereas all PPSI hospitals averaged a total of 18 claims per year and projectwide during the baseline period, that number dropped to 10 in 2009 and is trending at eight for 2010. Findings on liability claims and losses are current through November 2012. Because it typically takes two years or longer for a claim to be filed after an injury, final liability claims and losses will not be closed for some time, notes Susan DeVore, Premier president and CEO.

Launched in 2008 by Premier and affiliate liability insurer American Excess Insurance Exchange, RRG (AEIX), PPSI participants are large and small, teaching and non-teaching, system-based and standalone, with employed and non-employed physicians. They represent 12 states, in which approximately 250,000 babies were delivered over the collaborative’s five years (2008-2012). “There’s no other area in a hospital where providers routinely treat two distinctly different patients at the same time,” DeVore says. “Even though childbirth is so complex and unique, serious adverse events during labor and delivery are rare. But they do occur. Sometimes they’re preventable, but they’re always devastating for babies, mothers, families, and care providers.”

The PPSI results to date suggest that the strategies used can lower the incidence of certain infrequent, though serious, birth injuries and their associated liability claims. And the diversity of the participating hospitals also lends well to possible replication of the project and its results nationwide, she says.