• William Riley, James W Begun, Les Meredith, Kristi K Miller, Kathy Connolly, Rebecca Price, Janet H Muri, Mac McCullough, and Stanley Davis.
• School for the Science of Health Care Delivery, Arizona State University, Phoenix, AZ.
• Health Serv Res. 2016 Dec 1; 51 Suppl 3: 2431-2452.

ObjectiveTo improve safety practices and reduce adverse events in perinatal units of acute care hospitals.Data SourcesPrimary data collected from perinatal units of 14 hospitals participating in the intervention between 2008 and 2012. Baseline secondary data collected from the same hospitals between 2006 and 2007.Study DesignA prospective study involving 342,754 deliveries was conducted using a quality improvement collaborative that supported three primary interventions. Primary measures include adoption of three standardized care processes and four measures of outcomes.Data Collection MethodsChart audits were conducted to measure the implementation of standardized care processes. Outcome measures were collected and validated by the National Perinatal Information Center.Principal FindingsThe hospital perinatal units increased use of all three care processes, raising consolidated overall use from 38 to 81 percent between 2008 and 2012. The harms measured by the Adverse Outcome Index decreased 14 percent, and a run chart analysis revealed two special causes associated with the interventions.ConclusionsThis study demonstrates the ability of hospital perinatal staff to implement efforts to reduce perinatal harm using a quality improvement collaborative. Findings help inform the relationship between the use of standardized care processes, teamwork training, and improved perinatal outcomes, and suggest that a multiplicity of integrated strategies, rather than a single intervention, may be essential to achieve high reliability.© Health Research and Educational Trust.

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