Implementing the Safer Baby Bundle for stillbirth prevention across Queensland maternity services using a modified breakthrough series collaborative.

Abstract

Background: Australia's ≥ 28‑weeks stillbirth rate is 19.5% higher than that of high‑income countries with the lowest rates. The Safer Baby Bundle (SBB) is a national initiative to reduce stillbirth in Australia targeting five components of antenatal care and is the key prevention strategy within National Stillbirth Action and Implementation Plan. This paper reports the experience in one Australian state that delivered the Safer Baby Bundle Improvement Project (SBBIP) to support clinical staff implementing the SBB. In the setting of extreme maternity workforce challenges compounded by the COVID-19 pandemic, the implementation used a modified Breakthrough Series Collaborative (BTS).

Methods: Over an 18-month period, antenatal services across Queensland used a modified BTS Collaborative approach, removing the need for teams to document Plan-Do-Study-Act cycles, use statistical process control (SPC) charts, document project progress scores and monthly reporting. Engagement during the improvement effort was assessed. A before-and-after multimethod study was used to evaluate the program. Routinely collected perinatal data, clinical audits, project administrative data and surveys of healthcare professionals and women receiving antenatal care were used to measure improvements before and after implementation, and logistic regression interrupted time series (ITS) analyses were used for comparisons of the outcomes.

Results: Despite disruptions from the COVID-19 pandemic, the SBB was implemented across antenatal services, and the modified BTS implementation strategy achieved positive results. Eighty-nine percent of the 45 enrolled teams were actively engaged in the improvement effort across the SBBIP and all (100%) implemented one or more change ideas. Post implementation, improvements were observed in all key process measures and balance measures (planned singleton birth before 39 weeks, late preterm and early-term singleton births), whereas other measures remained unchanged. The stillbirth rate ≥ 28 weeks in singletons remained at 2.1 per 1000 births before and after implementation. ITS analyses of eligible measures supported these patterns.

Conclusions: In an environment challenged by workforce shortages, high workload demand, and competing priorities (global pandemic), a modified BTS Collaborative approach is a useful model to implement improvement at scale to reduce stillbirth risk factors.