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AIM UPDATES Gillian Burkhardt October 26th, 2019 NMPC Annual Meeting

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Page 1: AIM UPDATES - NM Perinatal

AIM UPDATESGillian Burkhardt

October 26th, 2019

NMPC Annual Meeting

Page 2: AIM UPDATES - NM Perinatal

ObjectivesUnderstand the goal of the AIM program

Review the implementation of NM AIM program

Review the data from the NM AIM program

Page 3: AIM UPDATES - NM Perinatal

Disclosures I have no disclosures

Page 4: AIM UPDATES - NM Perinatal

What is AIM?

Page 5: AIM UPDATES - NM Perinatal

Goal: To eliminate preventable maternal mortality and severe morbidity at every US birthing center 2015

2019

Joined 2018

Page 6: AIM UPDATES - NM Perinatal

AIM National

Build national collaboration among states around maternal mortality and morbidity

Improve data capacity

Strengthen community partnership

Approach maternal health with an equity lens

Expanded focus in maternal mortality and morbidity (opioid use disorder, rural health challenges, etc.)

Page 7: AIM UPDATES - NM Perinatal

Safety bundles

Page 8: AIM UPDATES - NM Perinatal

Safety bundles

Make it easy to do the right thing

Hardwire a culture of safety into practiceEducation, training, order sets, protocols,

the environment

We must know the differenceBuild measurement into the process

NEW TJC STANDARDS on HTN and PPHCOMING IN JULY 2020 to a survey near you….

Page 9: AIM UPDATES - NM Perinatal

It Worked in California

22.7

28.6

18

28.2

0

5

10

15

20

25

30

35

AIM Bundle Group Comparison Group

Change in Postpartum Hemorrhage Rate among CA Hospitals With and Without AIM Bundle

Baseline Hemorrhage Rate Post-intervention Hemorrhage Rate

P=0.771

Main, EK et al. Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative. AJOG; March 2017.

Page 10: AIM UPDATES - NM Perinatal

Obstetric Hemorrhage Safety Bundle

Readiness: (every unit) Hemorrhage Cart / with Procedural Instructions (balloons, compression stiches) Rapid access to hemorrhage medications (kit or equivalent)

Recognition: (every patient) Assessment of hemorrhage risk (prenatal, on admission, ongoing in labor & PP) Measurement of CUMMULATIVE blood loss Active Management of 3rd Stage (oxytocin after birth)

Response: (every hemorrhage) Unit-standard, stage-based OB Hemorrhage Emergency Management Plan

w/checklist Support program for patients, families and staff

Reporting / Systems Learning: (every unit) Establish a culture of Huddles for high-risk patients and post-event debriefings Review all stage 3 hemorrhages for systems issues

Page 11: AIM UPDATES - NM Perinatal

IMPROVING PERINATAL HEALTH ECHO

Linking NM hospitals through Project ECHO to roll out the OB Hemorrhage Bundle

Page 12: AIM UPDATES - NM Perinatal

ECHO SESSIONS1st and 3rd Monday12:00-1:00

Introductions

Lecture/Didactic Presentation15-20-minute presentation by expert/specialist on an issue related to improving perinatal health

Case PresentationsParticipants present real cases (patient and systems) to discuss with the network and receive advice from subject matter experts and community No Protected Health Information (PHI) (i.e. no names, initials, birthdate (except year), address/city/tribe

Use ECHO ID when referring to patient

Wrap-up

The ECHO Model is “all-teach, all-learn”

Page 13: AIM UPDATES - NM Perinatal

Case presentation

Requested of all enrolled sites

Patient or systems focus

Identify specific clinical/systems/bundle implementation question related to case

Facilitated discussion including feedback from entire network

Recommendations are consolidated with formal feedback provided to presenting site and network

Page 14: AIM UPDATES - NM Perinatal

IPH EHCO Curriculum

Page 15: AIM UPDATES - NM Perinatal

Enrolled sites

Lincoln County Medical Center

Holy Cross

University of New Mexico

Mimbres Memorial Hospital

Rehoboth McKinley Christian Health Care Services

Gerald Champion

Miners Colfax Medical Center

Lovelace Westside Hospital

San Juan Region Medical Center

Presbyterian Hospital

Lovelace Women’s Hospital

Presbyterian Santa Fe

Christus St. Vincent's Regional Medical Center

Gallup IHS**

Shirprock IHS**

Page 16: AIM UPDATES - NM Perinatal

0.90%

0.70%

0.80%

0.80%

0.80%

0.80%

0.80%

0.90%

1.10%

0.50%

1.00%

1.20%

0.70%

0.40%

1.10%

0.70%

0.70%

0.70%

0.80%

0.00% 0.20% 0.40% 0.60% 0.80% 1.00% 1.20% 1.40%

Alaska (10)

California (172)

Florida (51)

Georgia (53)

Illinois

Indiana (24)

Maryland

Michigan

NPIC

Nebraska (30)

New Jersey

New Mexico (10)

Oklahoma (33)

Premier (50)

Tennessee (13)

Texas (215)

Trinity (30)

Utah (30)

Virginia (54)

West Virginia

Severe Maternal Morbidity Among ALL Delivering Women(COLLABORATIVE TIME - prior to AIM participation)

Page 17: AIM UPDATES - NM Perinatal
Page 18: AIM UPDATES - NM Perinatal

Structure measures

46.20%

76.90%

46.20%

92.30%

69.20%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Patient family support Debriefs Multidisciplinary CaseReviews

Hemorrhage Cart Hemorrhagepolicy/procedure

Page 19: AIM UPDATES - NM Perinatal

Process Measures

49.20%

70%

75%

59.20%

52.50%

85.80% 85%

67.50%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Provider education Nurse education Hemorrhage RiskAssessement

QBL measurement

Q2 Q3

Page 20: AIM UPDATES - NM Perinatal

AIM TEAM

Curriculum Team

• Gillian Burkhardt*

• Eve Espey

• Abigail Reese

• Katrina Nardini

• Tamara Rendon

• Octavia Djanquaye

Data Team

Ellen Interlandi*

Katie Avery

Eirian Coronado

Jean Howe

Melissa Schiff

Trevor Quiner

Gillian Burkhardt

Abigail Reese

Gillian Burkhardt: Co-state lead

Abigail Reese: Co-state lead

Eve Espey: Co-medical director, AIM state lead

Katie Avery: DOH

Eirian Coronado: DOH

Katrina Nardini: ACNM

Tamara Rendon: AWHONN

Ellen Interlandi: NM Hospital Association

Melissa Schiff

Trevor Quiner

AIM State Executive Team

Page 21: AIM UPDATES - NM Perinatal

Partners

AND YOU!

Page 22: AIM UPDATES - NM Perinatal

Where do we go next?

Page 23: AIM UPDATES - NM Perinatal

Afternoon breakout sessions

12:55 – 1:25: Where do we go next? What does your facility/community need from

the IPH ECHO?

What does your facility/community need from the NMPC?

1:25-1:55 and 1:55-2:25: Breakout groups Large conference room: QBL

Small conference room: Defining a debrief

Atrium: PPH sims

Page 24: AIM UPDATES - NM Perinatal

Contacts

NM Perinatal Collaborative: [email protected]

ECHOPerinatal:[email protected]

mailto:[email protected]
mailto:[email protected]

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