There have been a growing number of statewide perinatal quality collaboratives (PQCs) since the first PQC was formed in California over 15 years ago. Currently there are 6 states with CDC Reproductive Division of Reproductive Health (RDH) funding for their PQCs: California, New York, Illinois, Massachusetts, Ohio, and North Carolina. 25 other states including Florida have established PQCs. The remaining 19 states either have PQCs in development or have unknown PQC status.The Florida Perinatal Quality Collaborative (FPQC) Obstetric Hemorrhage Initiative, which had its kickoff meeting on October 30, 2013, is comprised of an alpha cohort of 32 hospitals from the state of Florida and 3 from North Carolina. The 32 Florida hospitals represent 2/3 of births in our state. The first initiative instituted by FPQC was an Obstetric Hemorrhage Initiative (OHI). Over the past 15 months, we have worked to implement strategies to reduce the risk of complications from obstetric hemorrhage, which is still a leading cause of maternal mortality, accounting for 15% of maternal deaths in Florida from 2005-2009.As the FPQC-OHI physician champion representative from the University of Florida, I personally can speak to many advantages and benefits of being part of this collaborative. Perhaps the most important benefit has been experiencing the camaraderie of working with a group with a shared goal of providing safer maternity care to the women in our state. FPQC has provided resources and support to aid in the successful widespread implementation of multiple action items. This is no small feat given the wide array of participating hospitals from smaller community to large tertiary care academic centers! Major accomplishments have included the implementation of obstetric hemorrhage risks assessments, transitioning from an “estimated” blood loss (EBL) to a “quantified” blood loss (QBL), implementing active management of the third stage of labor, and implementing an obstetric hemorrhage policy and simulation drills. As part of a collaborative, we have been given many resources so as not to re-create the wheel, we have benefitted from prior lessons learned, and become part of a larger group with a shared mission to improve patient outcomes for our women in Florida. We look forward to further expanding these efforts as we recruit more hospitals into our collaborative.

The purpose for founding the FPQC was to improve Florida’s maternal and infant health outcomes through the delivery of high quality, evidence-based perinatal care. The FPQC success has been five years of such great partnerships (March of Dimes (state and national), DOH (CMS and MCH leadership), ACOG, AAP, FHA, AWOHHN, obstetricians, nurse midwives, pediatricians, neonatologists, nurses, hospitals and their administration, academia, etc.), collaborations and lots of work. I still remember the first meeting of the group to discuss how this would work and through dedication and commitment it has not only "worked" but has been extremely successful. The FPQC’s MCH and Neonatal initiatives that have taken place have already made a significant difference in the lives of mothers and babies they have touched. I have been honored to be a part of the establishment and ongoing work of the FPQC and look forward to many more years of accomplishments and recognition of the tremendously valuable work of the Collaborative.

I represent Baptist Health of Miami, and my role is performance improvement in managing our perinatal outcomes. I was asked a year ago to spearhead our HTN Crisis Management program and be the representative with the FPQC initiative which has given us a direction utilizing EBP and standardized protocols. Prior, we were on the journey utilizing ACOG guidelines but were looking for a more comprehensive way to tackle all of our roadblocks in managing these high risk Perinatal patients. Our #1 adherence was assuring all HTN crisis patients no matter where they showed up in our hospital, were all managed with the standardized order sets and treated within 1 hour. We already had a HTN collaborative team in place and met monthly, set goals, made sure the message went out via our OB Champion that all medical staff, nursing, leadership, pharmacy, ICU, and ER, were all on board and promoted the HTN Crisis orders sets/algorithms. We even presented this Best Practice in our annual EBP/PI Fair so that the entire hospital was alert to our initiative. We have seen a vast improvement in our management of our HTN crisis patients, with LOS, decrease in costs and mostly giving the nurses a standard of care to manage these high risk patients. No more guessing when to recheck the blood pressure, which blood pressure medication will be given and when to call the physician. With crystal clear EBP order sets, this allowed the front line involvement, nursing, help drive the right care with timely recognition and quick ,organized response with the medical team. We are proud to be part of the FPQC initiative and continue to track our data and share our successes and opportunities for improvement.

The Florida Perinatal Quality Collaborative is an excellent interdisciplinary forum improving perinatal health care in Florida. The FPQC provides the opportunity for perinatal health care professionals from across the state to come together and address and improve perinatal health care. The forum ensures current standards are incorporated along with current relevant research. Best practices and experts from other state collaboratives are also shared. My personal experience has been as the RN representative for AWHONN Florida on the Obstetric Hemorrhage Initiative (OHI). At our first face to face meeting, Nurses, Obstetricians, Perinatologists, Neonatologists and Advanced Practice Nurses came together to create a tool kit that is evidenced base and clinically relevant. Ongoing conference calls were held to ensure a valid and reliable tool kit was developed. I enjoyed the collaboration among AWHONN, ACOG, SMFM, ACNM, Public Health and JC experts during these meetings. Sharing best practices has been very helpful in order to create a tool kit that can be utilized and customized by each hospital. Many of us use the same EMR which has been very helpful. Hospitals are also able to bring an issue to our group for consultation. We have a panel of experts prepared to help hospitals across Florida provide the best care for our Mothers and Babies. Overall, it is rewarding to be a part of such a collaborative interdisciplinary health care forum.

As an obstetrician, my priority has always been optimizing outcomes for my patients based on current best practices. The Florida Perinatal Quality Collaborative supports all of our providers at Tampa General in this work and allows our providers to compare our performance to hospitals operating in similar contexts in the state. The FPQC motivates collaborative members to improve by sharing benchmark performance and by sharing approaches to common obstacles to improvement. Tampa General Hospital has participated in both state and nationwide projects with the collaborative including the Reduction of elective deliveries <39 weeks sponsored nationally by the March of Dimes, and the statewide Obstetrical Hemorrhage Initiative. Personally, it has been very satisfying to me to work closely with a multidisciplinary team at the hospital including nursing staff and administration to improve outcomes for our moms and babies. The FPQC and its programs have facilitated that interaction to a degree I never thought possible.

Our hospital joined the FPQC Obstetric Hemorrhage Initiative and gained a wealth of knowledge and a network of committed professionals. Prior to joining the FPQC, we had developed a system wide approach to Obstetric hemorrhage, but were “stuck” with regard to quantification of blood loss. Participation in the FPQC helped us refine our approach and take our practice to a higher level. We gained innovative approaches to managing change within our Operating rooms to measure blood loss, as well as new and innovative ideas for critical event debriefs. One advantage of the FPQC is that it combines both Nurse and Physician leaders that are “in the trenches” as well as university based physicians. Through participation in the collaborative you are exposed to knowledge from both community and urban hospitals that can be modified for a particular environment or problem. There is deep commitment to patient care, and an overriding sense of encouragement and support to initiate and incorporate the most current and evidence based practices. Participating in the FPQC helped our hospital’s Nurses, Obstetricians, and Anesthesiologists collect data, examine the data and make changes in a unified manner to improve safe maternal and neonatal care.

“The site visit allowed our system to meet in a multi disciplinary fashion, with all levels of exposure and knowledge to the HIP initiative. As a group our HIP expert was able to review our hospital specific data as well as give the background research to reinforce why the project is being done and the evidence to support the changes we are making. The FPQC continues to be an excellent source of support and knowledge to improve the care we are able to deliver to our patients – thank you."
- Sarah DiGiorgi, MD

"We provided an overview of our efforts and sought feedback from Betsy Woods and Karen Harris. They were incredible! Their insights were helpful, noncritical and both had keen understandings of the complexity of healthcare and recording and collecting necessary research data. Having another set of eyes look at the issues was very helpful to our team. Even having participated in the quality effort from the start, I learned many things from this onsite visit, particularly about the initiative’s data collection that was not apparent to me. After the visit we were provided a summary of the findings and a check list of action items. I am grateful for the site visit and would be surprised if other groups do not find it equally useful."
- Bob Egerman, MD

“It was very valuable to have the FPQC team review our current work flow and practice. They helped us identify several opportunities for improvement and we walked away with several actionable items to improve our care.”
- Carol Lawrence, PhD, MS, BSN