1. Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN

Article Content

Quality improvement efforts and participation in perinatal quality collaboratives have numerous benefits including consistent application of the latest evidence and best practices to clinical care, promotion of teamwork and interdisciplinary collaboration, objectively assessing quality of care and outcomes, and supporting optimal maternal and neonatal health (Simpson, 2021). Clinicians and health care leaders can work in groups across systems and disciplines and benefit from the expertise of those with more resources and who have the ability to synthesize the latest evidence and clinical guidelines as the foundation for toolkits, practice protocols, and patient safety bundles, rather than the outdated and time-consuming approach of each hospital or health care system attempting to develop their own. Wide dissemination and sharing of these documents promote patient safety (Alliance for Innovation on Maternal Health, 2020).


Last August 2021, the Centers for Medicare and Medicaid promulgated a new requirement for measuring patient safety in birthing hospitals in the United States as part of the Hospital Inpatient Quality Reporting Program (Centers for Medicare and Medicaid Services, 2021; Department of Health and Human Services, 2021). A maternal morbidity structure measure will allow data collection on birthing hospitals' participation in perinatal quality collaboratives at the system, state, and national level, and their adoption of key perinatal patient safety bundles in maternal complications, including, but not limited to, hemorrhage, severe hypertension, preeclampsia, or sepsis. The goal of the measure is to encourage hospitals, health care systems, and clinicians to do all that they can to improve the quality of maternity care and birthing outcomes for mothers and babies. It is widely acknowledged that maternity care in the United States has less favorable outcomes when compared with peer countries (Aspen Health Strategy Group, 2021; National Academies of Sciences, Engineering, and Medicine, 2020), so we need to do better. Data collection on the new measure began October 2021.


Perhaps being required to publicly report involvement will encourage leaders in more birthing hospitals to actively participate in perinatal quality collaboratives and adopt perinatal patient safety bundles. Participation requires a commitment from administrative and clinical leaders to support clinicians in applying the evidence and collecting process and outcomes data. Budgetary support is needed for nurses, midwives, physicians, and quality professionals to facilitate meaningful participation. Adoption of the perinatal patient safety bundles takes time and leadership to encourage and support all clinicians. It will be several years before we know if this new maternal morbidity structure measure makes a difference in maternal morbidity and mortality; however, this is a step forward in working to improve outcomes.




Alliance for Innovation on Maternal Health. (2020). Patient safety bundles. Washington, DC.[Context Link]


Aspen Health Strategy Group. (2021). Reversing the U.S. maternal mortality crisis, 1-146. Washington, DC: The Aspen Institute.[Context Link]


Centers for Medicare and Medicaid Services. (2021). Hospital inpatient quality reporting program. Baltimore, MD: United States Department of Health and Human Services.[Context Link]


Department of Health and Human Services. (2021, August 13). Centers for Medicare & Medicaid Services 42 CFR Parts 412, 413, 425, 455, and 495; Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2022 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Changes to Medicaid Provider Enrollment; and Changes to the Medicare Shared Savings Program. Federal Register, 86(154), 1-841. Rules and Regulations.[Context Link]


National Academies of Sciences, Engineering, and Medicine. (2020). Birth settings in America: Outcomes, quality, access, and choice. The National Academies Press.[Context Link]


Simpson K. R. (2021). Perinatal patient safety and quality. In K. R. Simpson, P. A. Creehan, N. O'Brien-Abel, C. Roth, & A. Rohan (Eds.), AWHONN's Perinatal nursing (5th ed., pp. 1-17). Wolters Kluwer. [Context Link]