Quality improvement efforts often use the phrase “share seamlessly, steal shameless” to describe the importance of learning from one another and building from each others’ strengths and past efforts.
With that sharing philosophy in mind, we’re happy to share that our first CHoSEN article will be published in Hospital Pediatrics (Volume 10, Issue 9, September 2020). The article is titled “The Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative: Standardization of Care for Opioid-Exposed Newborns Shortens Length of Stay and Reduces Number of Infants Requiring Opiate Therapy” and includes aggregated CHoSEN QIC data from April 2017 to December 2019 demonstrating our statewide collaborative’s reductions in average LOS, the percentage of OENs requiring opiate therapy, and average LOS for OENs requiring opiate therapy.
Thank you to all the participating CHoSEN hospital teams who have made this opportunity to share our work with the broader pediatric community possible!
The CHoSEN QIC team is developing additional manuscripts to continue to share our lessons and successes, including a draft manuscript analyzing demographic disparities. If your hospital team is interested in disseminating your hospital’s work--whether to your C-suite, for a conference, or for publication, support is available. Please contact Dr. Susan Hwang to get the ball rolling to seamlessly share.
Lutheran Medical Center is one of the founding hospitals of the CHoSEN Quality Improvement Collaborative. Jillian Adams, director of strategic initiatives for Illuminate Colorado sat down with Dr. Erica Wymore to discuss how she and the team at Lutheran Medical Center are utilizing their electronic health record (EHR) system to support their hospital’s CHoSEN practice changes, particularly related to breastfeeding practices.
Dr. Wymore is the Medical Director of the Newborn ICU at Lutheran Medical Center, a faculty member at the University of Colorado School of Medicine, and a member of the Steering Committee for CHoSEN QIC has been part of this effort from the beginning, continuing to innovate around supporting opioid-exposed newborns and their families.
The Challenge: Communication Across Mother and Infant Provider Teams
Examination of data across CHoSEN hospitals revealed variability among breastfeeding rates for substance-exposed newborns, leading to a desire to improve these rates among mother-infant dyads affected by a substance use disorder.
To begin addressing this need, Lutheran Medical Center worked to create a process map to help them understand, reflect on, and identify room for improvement in their policies and procedures for determining a dyad’s breastfeeding eligibility and effectively and consistently communicating it between providers and to families.
Engaging in this process led to the identification of a challenge with ensuring that important information from the mother’s medical record and provider team is reflected in the infant’s medical record and shared with the infant’s provider team.
The Solution: Ask What Your EHR System Can Do for You
With this challenge identified, the team at Lutheran began collaborating with their electronic health record provider to develop improved and automated workflows within their EHR system to ensure that important information related to a mother-infant dyad’s breastfeeding eligibility is available in all of the necessary places. Watch the interview with Dr. Wymore to learn more about how Lutheran Medical Center developed their process map and is working with their EHR provider to create new workflows.
Looking for Solutions for your Hospital?
If your site is interested in implementing similar innovations, Dr. Wymore advises developing a process map to identify your hospital’s key players and then working to provide clear and consistent education that will ensure families affected by prenatal substance exposure receive the best and most consistent care. CHoSEN QIC is able to support hospitals through these innovations by conducting a virtual site visit and helping teams with steps like developing a process map. To request and schedule a virtual site visit, contact Jessica Scott.
Addressing the Shortage of Providers in Colorado able to Prescribe Treatment for Patients with Opioid Use Disorder
For the last decade, overdose has been a leading cause of pregnancy-associated death in Colorado. Colorado providers have a unique opportunity to aid persons struggling with opioid use disorder (OUD) during the vulnerable perinatal period.
Buprenorphine can be prescribed during routine clinical care, including primary care, family practice, psychiatry, and the emergency department, to treat individuals with prescription opioid or heroin addiction, including during pregnancy and postpartum. With the increasing prevalence of maternal OUD and overdose deaths in the state, it is imperative that treatment resources for these patients increase.
However, there is a shortage of providers in Colorado who are able to prescribe buprenorphine treatment for patients with OUD, and even fewer trained to care for the perinatal population.
To address this need, the Practice Innovations in Opioid Management at the CU Department of Family Medicine is offering a stipend for Colorado providers who invest the time to take the waiver training to get their DEA X waiver. Those who complete a waiver training course and receive their waivers from DEA by September 30 will be eligible to receive up to $1000 in compensation.
Amidst the Coronavirus (COVID-19) pandemic, multidisciplinary professionals who support families with newborns prenatally exposed to substances from across the state of Colorado convened virtually on May 12th for the Spring CHoSEN Forum to share updates and learn from each other’s successes and challenges in implementing related quality improvement efforts.
Dr. Susan Hwang shared updates on the CHoSEN Collaborative’s hospital-level efforts, including the network’s growth to over 30 hospitals across three states and 2017-2020 data from hospitals within the CHoSEN cohort, including average lengths of inpatient stays for opioid-exposed newborns, percentages of opioid-exposed newborns who received pharmacologic therapy, and the racial and ethnic disparities that exist within those statistics.
Hear from subject matter experts, share your challenges and progress and learn from your colleagues at the Virtual Spring CHoSEN Forum.
Virtual Spring CHoSEN Forum
Tuesday, May 12, 2020
9:30 am - 12:30 pm
Don't miss our forum keynote:
Caring for the Opioid-Exposed Mother Infant Dyad Across the Perinatal Continuum
Davida M. Schiff, M.D.
Medical Director of the HOPE Clinic (Harnessing support for Opioid and substance use disorder in Pregnancy and Early childhood) at Massachusetts General Hospital
Virtual attendees will also have the opportunity to participate in a breakout discussion with colleagues from around the state on one of the following topics:
The Colorado Department of Human Services (CDHS) is required by key federal legislation addressing child abuse and neglect known as "CAPTA" to ensure that families with a newborn born affected by substance exposure have a "plan of safe care" that addresses both newborn and caregiver needs. Discharge of any infant exposed to substances, prescribed or illicit, should include careful planning and involvement of a multidisciplinary team.
Medical providers, child welfare professionals, and treatment providers are invited to this Plans of Safe Care Kickoff Event to learn more.
Please join representatives from Illuminate Colorado, Colorado Hospital Substance Exposed Newborn Collaborate (CHoSEN), the CDHS Office of Behavior Health and the Division of Child Welfare for presentations on Colorado's collaborative approach to engaging families with substance exposed newborns.
Discussions will focus on multidisciplinary outreach, coordination and partnership to support the implementation of the Comprehensive Addiction and Recovery Act (CARA) provisions, and the Plans of Safe Care, a requirement of Child Abuse Prevention and Treatment Act (CAPTA).
Plans of Safe Care Kickoff Event
Tuesday, March 3, 2020
9 AM to 3 PM
Summit Conference & Event Center
411 Sable Blvd.
Aurora, CO 80011
Download the agenda.
For more information contact Suzy Morris (303-866-4268 or firstname.lastname@example.org).
Areas of Focus at the event include:
Video series available for providers and family to learn more to improve the lives of newborns prenatally exposed to substances.
The CHoSEN Collaborative has create a short series of videos for inpatient providers, outpatient maternal providers and outpatient pediatric providers to learn about:
Visit the Provider Video Resource Library to choose the video series that is right for you.
The CHoSEN Collaborative has also created a patient and family-friendly video series to learn about the CHoSEN Collaborative, breastfeeding, non-pharmacologic care, safe discharge, and eat, sleep, console care for a new baby.
Share the CHoSEN family video series with your patients.
Email us if you are a provider or a hospital and you would like to embed any of the CHoSEN videos on your website.
Sincere thanks to the staff of Denver Health for providing a location to film this educational series of videos, – especially to the wonderful and compassionate staff of Denver Health’s Neonatal Intensive Care Unit.
CBS4 Denver Reporter Talks with CHoSEN Collaborative Member Promoting Best Practices for Babies Born with Opioid Exposure
"Colorado doctors are changing the way they care for these babies," reports CBS Denver anchor Britt Moreno. Moreno interviewed Colleen M Wheeler, a specialist in Neonatal-Perinatal Medicine with Lutheran Medical Center, a CHoSEN Collaborative participating hospital, about change in practices to support newborns exposed to Opioids, as well as trends in Denver. CHoSEN Collaborative hospitals are implementing best practices to support families of newborns prenatally exposed to substances throughout the Rocky Mountain region.
Moreno also sat down with a mother of two to talk about her experience being pregnant and trying to combat addiction in the hopes of reducing stigma surrounding getting treatment.
Watch the video below or read the original story on CBS4 Denver
Hospital Collaborative Driving Practice Changes for Substance Exposed Newborns
DENVER, CO (November 27, 2019) — Nearly 50 percent of Colorado births occur in a hospital participating in a quality improvement collaborative, coordinated by a group known as the Colorado Hospital Substance Exposed Newborns Collaborative (CHoSEN Collaborative), to improve outcomes for newborns prenatally exposed to substances. Previous publicly reported cases of Neonatal Abstinence Syndrome (NAS) in Colorado had been found to increase by 120 percent from 2011 to 2016 based on hospital discharge coding data. NAS is a group of withdrawal symptoms resulting from the sudden discontinuation of fetal exposure to substances that were used by the woman during pregnancy. Among participating hospitals, the prevalence of prenatal opioid exposure in newborns has been found to be nearly double that of publicly reported estimates.
Dr. Susan Hwang, the physician champion of the CHoSEN Collaborative and neonatologist at Children’s Hospital Colorado and University Hospital, attributes the increase to a change in the way patients are identified as a result of practice changes. “We have the opportunity as providers not only to improve our practice while engaging families in the care team, but also to improve measurable outcomes for newborns and families impacted by substance use during pregnancy,” said Hwang.
The CHoSEN Collaborative has been leading the effort to increase consistency in implementation of best practice approaches in the identification of and response to newborns prenatally exposed to substances in the Rocky Mountain region since 2017. Multidisciplinary hospital-based improvement teams track data and achieve measurable improvements for infants and families impacted by substance use.
Hwang shared CHoSEN Collaborative’s aggregate data at a quarterly forum organized by the CHoSEN Collaborative earlier this month, demonstrating a drastic decrease in length of stay for opioid-exposed newborns and an increase in prenatal counseling and service referrals for families. Over seventy clinicians from hospital newborn intensive care units and mom and baby units from Colorado and Wyoming gathered in Glenwood Springs, Colorado to share best practices around caring for women and newborns impacted by substance use, especially opioids.
“We have reduced the average length of stay for a newborn from more than two weeks to just six days, and the percent of opioid-exposed newborns being treated with opiate medications has declined from nearly 70 percent to less than 10 percent,” said Hwang.
Among the CHoSEN forum participants, Laurale Cross, the administrative director of the Women and Children Services Department at Valley View Hospital, located in Glenwood Springs. “When you are located in a small place, it is difficult to be aware of best practices and stay up to date on the latest research. That is one of the most important things the CHoSEN Collaborative does for hospitals,” shared Cross.
Seventeen birthing hospitals are committed to the CHoSEN Collaborative Quality Improvement Collaborative. The best practice approaches include: training on behavioral techniques to sooth babies experiencing withdrawal symptoms, as an alternative to prescribing opiates; providing tools for creating safe discharge plans; and guidelines for safe breastfeeding for mothers impacted by substance use, especially opioids.
The CHoSEN Collaborative is coordinated and led in partnership by the Colorado Substance Exposed Newborns Steering Committee, a subcommittee of the Colorado Attorney General’s Substance Abuse Trend and Response Task Force, chaired by Illuminate Colorado, and in collaboration with the Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and the Colorado Perinatal Care Quality Collaborative.
“We know from experience that collaborative action is most effective in achieving healthier outcomes for moms and babies,” shared Jaime Cabrera, executive director of the Colorado Perinatal Care Quality Collaborative (CPCQC), Colorado’s maternal and infant care quality network.
“We are continuing to drive a conversation around reducing barriers and stigma to accessing care for families impacted by substance use disorders in practice and policy during the upcoming legislative session in Colorado,” said Jade Woodard, executive director of Illuminate Colorado and co-chair of the Colorado Substance Exposed Newborns Steering Committee, a subcommittee of the Colorado Attorney General’s Substance Abuse Trend and Response Task Force. It will take all of us—clinicians, advocates, and most importantly families—to ensure our policies and practices are building systems to strengthen families,” said Woodard.
Hospitals participating in CHoSEN Quality Improvement Collaborative include:
Professionals not associated with a participating hospital are also encouraged to access resources available at www.chosencollaborative.org, including a New FREE tool gives Colorado perinatal providers access to hundreds of resources related to perinatal substance use paid for through a grant from the Colorado Department of Public Health and Environment.
Colorado Perinatal Care Quality Collaborative (CPCQC) is a statewide nonprofit network of hospitals, healthcare facilities, clinicians and public health professionals that improves the health of women and infants through continuous quality improvement. Visit cpcqc.org to learn more.
Illuminate Colorado is a statewide nonprofit organization building brighter childhoods through education, advocacy, and family support to prevent child maltreatment. Visit IlluminateColorado.org to learn more.