| Primary Author: | William Riley, PhD |
| Co-Principal Investigators/Collaborators: | Carmen Parrotta, MPH, Aundrea Price, MBA, Kath Connolly, RN, MSEd, CPHRM, Kristi Miller, RN |
| Organization | School of Public Health, University of Minnesota |
Abstract
Purpose
The purpose of this study is to examine the determinates for rate and magnitude of change that are associated with the implementation of care bundles in hospital perinatal units. The aim was to create high reliability in obstetrics units to achieve 100% compliance with specific interventions shown to improve perinatal safety.
Background
Substantial evidence has accumulated regarding the results of quality improvement (QI) methods and techniques in acute care settings. However, the improvement science underlying these interventions is shallow and limited. Very little is known regarding the rate and magnitude of change for uptake of evidence- based practices at the microsystem level.
Materials & Methods
The research is a prospective quasi-experimental, mixed methods design with a time-series analysis to determine the effects of three evidence-based care bundles on unintended perinatal harm. These findings study of 32 hospitals across the country, representing approximately 300,000 births over the 36 month intervention period. A qualitative analysis is conducted to explore the organizational determinants and human factors associated with bundle compliance. We use odds ratios, control charts and Kendall’s Tau for the data analysis.
Results
Compliance with evidence based care bundles substantially improved for all three bundles: (Elective Induction – 52 percent, Augmentation – 118 percent, and Vacuum – 55 percent). Moreover, out of 14 hospitals, six hospitals were able to sustain criterion for the induction bundle, one for the augmentation bundle and two for the vacuum bundle. A qualitative analysis indicates four leading barriers to bundle compliance; question appropriateness of practice, competing initiatives, resistant staff, and latent deficiencies in the system.
Conclusion
The organizational determinants of bundle compliance rates illustrate important relationships between organizational context and the ability to adopt best practices which can be leveraged to target quality improvement project and training programs. These findings advance the science of improvement regarding how to implement such processes, the rate and magnitude of adopting standardized processes, and what causes processes to deteriorate.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).