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2024 Annual

Report

TIPQC seeks to promote meaningful change, advance health, improve outcomes, and improve the quality of care through pregnancy, delivery, and beyond for all Tennessee families.

Letter from the Chair of the oversight committee
oversight committee
Operations staff
Continued Leadership in Projects
Impact Stats

Letter from the Oversight Committee Chair

This year’s Annual Report comes at a time of great tumult and widespread uncertainty. It’s as if each day brings new feelings of insecurity, especially around healthcare. So, I’m grateful for the opportunity to once again celebrate and renew our commitment to quality care for pregnant women and their babies. We have much to be proud of in 2024, including:

• The Intraventricular Hemorrhage project, part of the Tennessee’s Tiniest Babies bundle of QI projects, touched 1,305 little lives in all 12 of the state’s Level III and IV NICUs, collectively showing a reduction in mortality.
• The Promotion of Safe Vaginal Delivery project saw widespread reductions in C-section deliveries, with 63% of the hospital teams achieving the goal of less than 23.6% of deliveries by C-section.
• New platforms to assist in our programs and projects, including Simple QI with three new projects using this platform to submit and analyze our data, and our website to help us stay connected as we embark on new projects.

The work we do is so important. Remember: mothers and their babies are our most vulnerable Tennesseans, and our greatest hope for a happy future. It’s up to all of us to redouble our efforts to improve their lives in our own backyards. To that end, I ask for your help in getting word out about the good work you do with TIPQC. I’m often challenged in meetings that TIPQC is only for big hospitals. You and I know differently. We are having a session at this Annual Meeting specifically targeted to community hospitals with Level II NICUs and Newborn Nurseries, so that we can brainstorm how to target projects appropriate for these settings and all of our labor and delivery hospitals across the state.

We also have more work to do in maternal cardiovascular disease that robs women of their young lives. In looking for some work-life balance, I binged some Downton Abbey and was reminded of Season 3, Episode 4. This is one of the saddest episodes in television in which the youngest sister dies of eclampsia in the early 20th century … and it still happens today. Let’s change that together.

With deep admiration for the work you do with us,

Susan Guttentag, MD
Principle Investigator

Oversight Committee, Chair

SUSAN GUTTENTAG, MD

TIPQC’s Impact from State and Hospital Leaders

“TIPQC is a leader and trusted partner in reducing preventable maternal and neonatal morbidity and mortality across Tennessee.” – Assistant Commissioner Elizabeth Harvey, PhD, MPH

“Our partnership with TIPQC is driving meaningful change in the neonatal and maternal health landscape across Tennessee. By supporting our member hospitals through TIPQC, we are collectively advancing the mission of ensuring that every mother and newborn in TN receives high quality and safe care. We recognize that these achievements would not be possible without the unwavering commitment and hard work of TIPQC staff and clinicians in TN. Thank you for your efforts.” — Tammy Van Dyk, Tennessee Hospital Association

 “I am always amazed to see so many folks from across Tennessee working together to improve the health of mothers and their newborns.”  — Brian Hackett, MD, PhD, Vanderbilt University Medical Center

“TIPQC continues to improve care for families across Tennessee and I am extremely proud to be part of this amazing team.  I love this summary of all the great work accomplished this year!!!” — Deena Kail, BSN, RN, MBA, VP of Operations/CNO, West Tennessee Women’s Center

“TIPQC is a champion of bringing evidence-based care to clinical practice. Twenty years ago, I was vilified for delayed cord clamping at birth, but today research has shown that the benefits for the baby are immense. Over 61,000 babies in Tennessee received this care through TIPQC’s Optimal Cord Clamping project. It is great to be part of TIPQC’s work to improve maternal and infant health in Tennessee.” — Margaret C. Taylor, DNP, CNM, FACNM, Tennessee Affiliate of the American College of Nurse-Midwives

“TIPQC continues to be a catalyst for change in our state!   The CCOC project will change the outcomes for so many women.  As facilities implement appropriate screening across the state, they will be able to recognize that cardiovascular disease continues to affect the mother long after she welcomes her baby.  Looking forward to seeing the success of this project!” — Jinni Malone, MSN, RN, C-ONQS, Women’s and Children’s Quality Manager, TriStar Centennial Medical Center

“The partnership between the state of Tennessee and TIPQC is an example of what happens when two dedicated entities join forces. By providing mothers with blood pressure cuffs and forming the Data Institute, we are not only empowering women to take control of their health but also leveraging data to drive innovation and improve outcomes. Together, we are setting a new standard for maternal health care—one rooted in compassion, evidence, and a commitment to saving lives.” —Yoshie Darnall, MSN, APRN, WHNP-BC, Maternal Health Programs Director, Tennessee Department of Health  

“It was an honor getting to be a part of the TIPQC Oversight Committee. Your leadership is so appreciated. TIPQC projects continue to make a significant impact in the lives of perinatal patients.” — Melanie Morris, PhD, AWHONN TN Section Chair

“The Maternal Mortality Review Program’s collaboration with TIPQC has been invaluable in our efforts to address and reduce pregnancy-related deaths across Tennessee.  Together, we are working to enhance provider education, strengthen healthcare systems, and ensure that every mother in Tennessee receives the quality care she deserves.”  – Tina Herring, RN, Maternal Mortality Review Program Director, Tennessee Department of Health 

“TIPQC has been a trusted, knowledgeable ally in TDH’s maternal health mission. This isn’t just about launching programs or collecting data; it’s about real people, real families, and the lives we can save together. We couldn’t ask for a better partner in this critical endeavor. Thank you TIPQC, for helping reshape the maternal health landscape in Tennessee.” – Crissy Hartsfield, Section Chief, Reproductive Women’s Health, Tennessee Department of Health

Oversight Committee

The Oversight Committee is critical to the work of TIPQC. Special thanks for their contribution to improved care for mothers and infants in Tennessee.

Jona Bandyopadhyay, MD, MPH, FACOG, Associate Medical Director, TennCare

Kerri Brackney, MD, Maternal Fetal Medicine, Regional One Health 

Tara M. Burnette, MD, Neonatologist, University of Tennessee Medical Center, Knoxville

Greg Cannella, MD, TN Medical Director, Government Business Division, Amerigroup

Susan Guttentag, MD, Chair – Oversight Committee, Julia Carell Stadler Professor of Pediatrics, Vanderbilt University School of Medicine, Director, Mildred Stahlman Division of Neonatology, Monroe Carell Jr. Children’s Hospital at Vanderbilt

Brian Hackett, MD, PhD, Professor of Pediatrics, Vanderbilt University Medical Center

Elizabeth Harvey, PhD, MPH, Assistant Commissioner and Director of the Division of Family Health and Wellness, Tennessee Department of Health

Deena Kail, BSN, RN, MBA, VP of Operations/CNO,  West Tennessee Women’s Center

Joseph Kipikasa, MD, Vice Chair and Residency Program Director, University of Tennessee Department of Obstetrics and Gynecology, Chattanooga Unit

Andrea Johnson, MD, Assistant Professor in Obstetrics and Gynecology, Vanderbilt University Medical Center

Jinni Malone, MSN, RN, C-ONQS, Women’s and Children’s Quality Manager, TriStar Centennial Medical Center

Sharon Moore-Caldwell, MD, MDiv, Medical Director, BlueCross BlueShield, BlueCare, TN

Melanie Morris, PhD, APRN, WHNP-BC, CCE, AWHONN TN Section Chair

Rhonda Okoth, MPH, BSN, RN, CCRP, Patient & Family Partner

Jack Owens, MD, MPH, Neonatology Division Director East Tennessee State University/NICU Medical Director Niswonger Children’s Hospital

Kiffany Peggs, MD, Chief Medical Officer, UnitedHealthcare Community & State

Shannon Rigler, MD, Medical Director of Neonatology, Erlanger Children’s Hospital

Sheri Smith, RN, East Tennessee Children’s Hospital

Ajay Talati, MD, Sheldon B. Korones Professor and Chief, Neonatology, Professor, Pediatrics and OB/GYN, Vice-Chair for Education, Pediatrics, Program Director, Neonatal-Perinatal Medicine

Danielle Tate, MD, MBA, Maternal Fetal Medicine and Previous TIPQC Maternal Medical Director 

Margaret C. Taylor, DNP, CNM, FACNM, Tennessee Affiliate of the American College of Nurse-Midwives

Tammy Van Dyk, MSN, MBA, RN, CENP, Senior Vice President, Quality & Patient Safety, Tennessee Hospital Association

Kevin Visconti, MD, Maternal-Fetal Medicine, High Risk Obstetrical Consultants

Lynlee Wolfe, MD, Assistant Professor, Maternal and Fetal Medicine, University of Tennessee Medical Center

Victor Wu, MD, MPH, Chief Medical Officer, Division of TennCare

________________________________________

Ex-Officio Brenda Barker, M Ed, MBA, TIPQC Executive Director

Ex-Officio Scott Guthrie, MD, FAAP, TIPQC Past Infant Medical Director

Ex-Officio Karen Schetzina, MD, MPH, FAAP, TIPQC Infant Medical Director

Ex-Officio Connie Graves, MD, TIPQC Maternal Medical Director

Ex-Officio Jessica Young, MD, MPH, Past TIPQC Maternal Medical Director

Ex-Officio Rolanda Lister, MD, TIPQC Health Officer

Sub Committee Members:  

Maintenance of Certification (MOC):  Tara Burnette, MD & Donna Whitney, MD

TIPQC Operations Staff

The TIPQC Infant and Maternal Medical Directors as well as the Quality Improvement (QI) Nursing Specialists provide expertise, passion, and knowledge to all the work of TIPQC.  The core team also includes QI, project, and data management expertise.

Read more

July 2024 – TIPQC’s Annual Leadership Retreat

I am excited to see TIPQC celebrate another successful year of making strides in Quality Improvement work across the state. The participating maternal and infant teams have worked so hard and remained dedicated to the mission of the organization, which is definitely appreciated and does not go unnoticed.  The successes of the PVD and TTB projects this past year are testaments to the TIPQC collective’s positive impact on sustaining quality perinatal care in Tennessee.” – Danielle Tate, MD, MBA, 2022-24 TIPQC Maternal Medical Director & State Project Leader

“At TIPQC, I believe that we champion care that prioritizes partnership and shared learning. By collaborating with Tennessee’s hospitals, nurses, providers, and communities, we have seen how purposeful actions—such as refining care pathways for cardiac conditions in pregnancy, integrating TeamBirth’s team-based communication models, and enhancing skills through Spinning Babies courses—can create safer journeys for families. For first-time mothers, we are advancing practices that promote safe vaginal delivery while honoring individual needs. Together, we are fostering systems where every family can access respectful care that empowers them to thrive.” – Bonnie Miller, MSN, RN Maternal QI Specialist, TIPQC

“Another great year of projects!  Great to have new teams join the projects and once again, I am in awe of how the teams share ideas and resources with each other.  There is truly a spirit of improving care for all mothers and babies across Tennessee.” —Patti Scott, DNP, APRN, NNP-BC, C-NPT

“2024 has been another year of amazing accomplishments! Hard working hospital teams, joined by patients, families, and communities, have completed two projects, with three more underway, and another project being developed.  We continue to hear and see how your efforts are paying off – improving the health outcomes for our moms and babies.  Thank you, Tennessee, for your commitment and unwavering desire to make our state truly the BEST for ALL!” — Brenda Barker, MEd, MBA

Continued Leadership and Vision with Quality Improvement Projects

For the past 16 years, TIPQC has developed high quality improvement projects to support the work of the local hospital teams, including patient and family partners, the community resources, and many other stakeholders.

At the Annual Meeting, future projects are discussed with “straw poll voting” indicating potential projects, which are calibrated for development based on state data and other trending concerns, best practices, and state, national, and international resources.

State Project leaders are selected based on expertise and have included this year:

Intraventricular Hemorrhage (IVH) Project:

Scott Guthrie, MD

Parul Zaveri, MD

Marcelo Rains, MD

Patti Scott, DNP, APRN, NNP-BC

Brenda Barker, M ED, MBA

Tanika Edwards, BSN, RN

Promotion of Safe Vaginal Delivery:

Danielle Tate, MD, MBA

Cornelia Graves, MD

Bonnie Miller, RN, MSN

Brenda Barker, M ED, MBA

Anastacia Volz, MPA

Chronic Lung Disease (CLD) Project:

Scott Guthrie, MD

Malinda Harris, MD

Vineet Lamba, MD

Marla Kirk, MBA, RRT

Patti Scott, DNP, APRN, NNP-BC

Brenda Barker, M ED, MBA

Alicia Mastronardi, MPH

BEST For All Project:

Karen Schetzina, MD, MPH

Rolanda Lister, MD

Bonnie Miller, RN, MSN

Patti Scott, DNP, APRN, NNP-BC

Anastacia Volz, MPA

Brenda Barker, M ED, MBA

Alicia Mastronardi, MPH

ACOG AIM Cardiac Conditions in Obstetric Care (CCOC) Project:

Cornelia Graves, MD

Lynlee Wolfe, MD

Bonnie Miller, RN, MSN

Brenda Barker, M ED, MBA

Tanika Edwards, BSN, RN

Necrotizing Enterocolitis (NEC) Project:

Scott Guthrie, MD

Eva Dye, DNP

Jack Owen, MD

Patti Scott, DNP, APRN, NNP-BC

Brenda Barker, M ED, MBA

Alicia Mastronardi, MPH

Lactation Taskforce

Brenda Barker, M Ed, MBA

Ginger Carney, MPH, RDH, LDN, IBCLC, RLC, FILCA, FAND

Gloria Dudney, RN, IBCLC, RLC

Briana J. Jegier, PhD

Tiana Pyles, MHA, CLC

Karen Schetzina, MD, MPH, FAAP

Pat Steimer, RN, IBCLC

Genae Strong, PhD, APRN, CNM, RNC-OB, IBCLC, RLC, CNE

Doula Training Taskforce

Alissa Claxton

Tiffany Clay

Kristin Meija

Rebecca Porter

Allison Rollans

Brenda Barker, M Ed, MBA

Tanika Edwards, RN, BSN

TIPQC’s 2024 Quality Improvement Projects

The Intraventricular Hemorrhage (IVH) project

The Intraventricular Hemorrhage (IVH) Project went into sustainment in June for new infants with final data collections on those infants in September 2024.  As part of the Tennessee Tiniest Babies Bundle, this project had 1,305 babies from all 12 of the Level III and Level IV NICUs.

Collaborative wide we did not see a decrease in sIVH during the course of this project. This may be due to the improvement in mortality which occurred with this project as more infants survived a sIVH as a result of our efforts.  Additionally, the small numbers or the heightened awareness on screening and identifying sIVH may have impacted the rates.  Mortality rates in the targeted population did show improvement. Initial baseline mortality rate for the three years prior to the start of the project was 14.2%. The mean mortality rate decreased to 10.7%.

Rates of sIVH and mortality will continue to be tracked in future Tennessee Tiniest Babies projects.  This continued tracking over several years will hopefully show a decrease in sIVH as teams are able to fully implement all process and structure measures.

sIVH Impact Statement

“I love being part of TIPQC. It makes me accountable for what should be done in our small NICU. It makes me more vigilant that despite our good numbers on several metrics, there is so much to improve on as well. The support of everyone in TIPQC is amazing.” – Jenda Arawiran, MD, Parkridge East Hospital

“It’s exciting to be part of this collaboration in Tennessee to reduce severe IVH. This initiative will positively impact countless families, leading to healthier outcomes across the state.”  – Marcelo Rains, MD, State Project Leader 

“While we haven’t yet shown an impact on sIVH, this project did impact the high mortality rate associated with this problem and with extremely preterm babies. This is an exciting trend for the first bundle of care developed for the Tennessee’s Tiniest Babies project.” – Scott Guthrie, MD, State Leader

The Promotion of Safe Vaginal Delivery (PVD) project

In November 2022, TIPQC kicked off the Promotion of Safe Vaginal Delivery project. By May 2023, what started with just six pilot hospitals had grown to include 29 more teams, all aiming to reduce the rate of c-section deliveries for first-time, full-term, single-baby (NTSV) pregnancies to under 23.6%.

Over the course of 18 months, these hospitals worked hard, putting into practice multiple evidence-based procedures and protocols. TIPQC was there every step of the way, offering educational opportunities through monthly meetings, in-person training sessions, and resource sharing.

In 2023 and 2024, TIPQC also sponsored 11 Spinning Babies® courses with Emma Moreland, CPM. These courses were designed to teach labor and delivery nurses, obstetricians, midwives, and doulas about different physiological techniques that can support vaginal delivery.

Each month, the teams reported c-section delivery rates among the NTSV population, both in general and after labor induction.  Reductions in c-sections were noted in some populations and at most hospitals during this project.

By September 2024, the project officially entered its sustainment phase. Over the duration of the project, teams reported on a total of 30,813 NTSV deliveries. In the most recent six months of data, 63% of teams had achieved an NTSV delivery rate of 23.6% or lower, and 60% hit that target after labor induction.

This initiative has been challenging, especially for the larger hospitals with more complex patient populations, but many hospitals saw significant improvements in their NTSV c-section rates. TIPQC is incredibly proud of the countless hours of hard work these teams put in to reduce unnecessary c-sections. We believe they’ll keep up the great work as they move forward with sustainment.

“We learned a lot along the way and really enjoyed the project.  Thank you for all the support we received from you and your team.”  – Colleen Chafatelli MSN, RN, RNC-ONQS, C-EFM  | Director of Perinatal Services, TriStar Centennial Medical Center  

“Thank you so much for your support. I love to be a part of something that makes us think on purpose on how to help these moms!” – Ashley Davis, RN, Women’s Services Director, TriStar NorthCrest Birthing Center

PVD Impact Statement

The BEST for ALL project

With over 23 faculty development meetings, the BEST for All Learning Collaborative received IRB approval in February 2024, piloted in the Spring, and began statewide in June 2024. 

The Best for All Learning Collaborative aims at ensuring respectful care for ALL patients. The Best for All project helps teams identify areas of improvement and integrate best practices into discharge teaching. The project utilizes a Patient Reported Experience Measure (PREM) survey to measure patient satisfaction with their care experience through tailored questions. TIPQC is providing teams with monthly webinars, resources including AWHONN’s Respectful Maternity Care Framework, and data management to ensure all teams have the resources they need to ensure every patient receives respectful care. Fifteen teams are currently taking part in this important project.

When the PREM Surveys started, we received this quote: “This is better than anything we ever got from other national surveys.”

“Our Best for All Learning Collaborative is excited to continue working together in 2025 and beyond to foster the provision of respectful care and improve maternal and infant care and outcomes.” – Karen Schetzina, MD, MPH, Infant Medical Director

“We are so grateful to the dedication and enthusiasm of our hospital teams to all of our patients and their families in Tennessee. This project is adding structure to our commitment to providing respectful care to all of our patients every time.” – Rolanda Lister, MD, State Project Leader

“It’s an honor to be able to support these hospital teams working throughout the state to ensure respectful, quality care for all patients- and in turn improve outcomes for ALL moms and babies in Tennessee!”- Anastacia Volz, MPA 

BFA Midterm Impact Statement

Teambirth

TeamBirth is a joint project endeavor with TIPQC and Ariadne Labs supporting open communication among patients, their support people, and clinicians during birth. “Through structured huddles and a shared planning board, TeamBirth empowers everyone to reach decisions together. The result is more dignified, respectful care that gives patients the role that they want.”

Five hospital teams  began in November 2023 to prepare and implement TeamBirth.  Two of our hospitals had to withdraw, and Hardin Medical Center was added.

Ascension St. Thomas Midtown, Regional One Health, and Hardin Medical Center have all launched TeamBirth. Baptist Memorial Hospital for Women will be launching in early 2025.  The University of Tennessee Medical Center, Knoxville (previously implemented) has also joined as a mentor. 

“On behalf of the Delivery Decisions Initiative at Ariadne Labs, we deeply value the collaboration between TeamBirth and TIPQC. Their partnership has been instrumental in advancing our shared mission of improving maternal health outcomes throughout Tennessee.”  — Trisha Short, BSN, RNC-OB, Senior Clinical Implementation Specialist, Delivery Decisions Initiative, Ariadne Labs

Learn More About TeamBirth

Chronic Lung Disease Project

The Chronic Lung Disease (CLD) Project was developed in the Fall of 2023, with IRB approval received in December 2023.  Pilot teams began work in January 2024, with state kick off in June 2024.

CLD or Bronchopulmonary Dysplasia (BPD) is defined as the need for oxygen or respiratory support at 36-weeks postmenstrual age.  It remains the most common complication of prematurity.  Infants who develop CLD have a higher incidence of mortality.  Morbidities are also higher in infants that develop CLD and include long-term neurodevelopmental delays and late onset sepsis.  Infants that develop CLD also have increased utilization of medical resources and are more likely to be readmitted to the hospital during the first year of life.

CLD incidence is inversely correlated with gestational age at delivery and is the highest among extremely low birthweight infants (<1000 g). While advances in neonatal care have significantly improved ELBW survival, BPD rates have not improved. Multiple factors contribute to CLD including mechanical ventilation, oxygen toxicity, infection, inflammation, and secondary lung injury. Collectively, improvements in these areas can reduce morbidity and mortality in preterm infants. 

Ten of the 12 TN NICUs are engaged in this ongoing project. 

“Thank you for helping the entire state’s NICUs make progress and improvement in so many important areas.”  – Kirk Bass, MD, University of Tennessee Medical Center, Knoxville

“There is great work being done across the state by the teams of the chronic lung disease project. Every team is working hard to make sure we are doing our absolute best for the babies across Tennessee and I’m so excited to see what we accomplish together!” – Malinda Harris, MD, East TN Children’s Hospital, State Project Leader

“Tennessee’s Tiniest Babies’ project to reduce chronic lung disease is a critical step towards improving care across the state.  We are focusing on innovative care strategies and hope not only to decrease mortality rates associated with this condition but also to significantly reduce the prevalence of chronic lung disease.  We’ve seen great enthusiasm and participation and can’t wait to see the impact.”  – Scott Guthrie, MD, State Project Leader

CLD Midterm Impact Statement

Cardiac Conditions in Obstetric Care Project

In conjunction with the Alliance for Innovation on Maternal Health (AIM), the TIPQC Faculty adapted the Cardiac Conditions in Obstetrical Care (CCOC) patient safety bundle, which received  IRB approval in December 2023.  The pilots worked through the Fall of 2024, when statewide enrollment began with a kickoff in October 2024.

 According to the most recent Tennessee MMR, the second leading cause of pregnancy related deaths was cardiovascular and coronary disease.  The goal of this project is to implement cardiac screening in pregnancy in ALL hospitals that provide obstetrical care, thus reducing unnecessary c-sections and premature births.

TIPQC traveled the state to the five perinatal regions hosting Emergency Department and Doula Resource Trainings to support this project.  Multiple resources including badge buddies, CVD Posters, Referral Cards, Screening tools, and CVD flyers were disseminated, along with 1,452 Preeclampsia Blood Pressure Cuff Kits. 

“As a state co-lead on the Cardiac Conditions in Obstetric Care Project, I am immensely impressed with Tennessee, who is one the first states to take on this important task, setting a standard in preventing maternal deaths and prioritizing maternal health.” – Lynlee Wolfe, MD, UTMCK

CCOC Midterm Impact Statement

2024 IMPACT

42 Hospitals (82% of births)

Involved in TIPQC Improvement Projects 

30,813 Pregnant Women

In the Promotion of Safe Vaginal Delivery Project.

1,305 infants

Enrolled in the IVH project.

1,452

Preeclampsia Blood Pressure Cuff Kits purchased for 27 hospitals and 50 doulas.

71,195

AWHONN POST BIRTH Warning Signs discharge magnets were ordered in 2024.

100,000 magnets & 49,725 brochures

Post Partum Support International resources given to hospitals and doulas to distribute to support pregnant & postpartum women (English, Spanish, Arabic, Mandarin).

130

Trained in Spinning Babies® in 2024 totaling 339 total trainees.

5 Doula Trainings & 5 Emergency Department Trainings

In conjunction with the Cardiac Conditions in OB Care Project.

5 SUD Trainings

Hosted throughout the state. Attendees received resource binders, magnets, and PSI magnets.

30 Hospitals

Represented at the first Data Institute.

166 Professionals Trained

At Postpartum Support International’s training in Memphis.

18 Community Organizations

Joined TIPQC’s Community Resource Council.

21,176

Downloads of the TIPQC Healthy Mom Healthy Baby Tennessee Podcast. 

7,242

Unique listeners to the TIPQC Healthy Mom Healthy Baby Tennessee Podcast.

22

Physicians earned 550 American Board of Pediatrics Maintenance of Certification (MOC) Credits.

RESOURCES

AWHONN POST BIRTH Warning Signs Magnets were purchased and distributed to 71,295 pregnant and postpartum women in 2024 in English, Spanish, Arabic, and Mandarin.  This is a total of 277,980 magnets distributed to 37 hospitals and over 50 doulas for postpartum Warning Signs the past few years.

Substance Use Disorder Screening & Referral Resource Binder 

TIPQC distributed binders to all SUD Disorder Screening and Referral attendees, consisting of over 30 different patient and provider resources including TennCare benefit information, mental health resources, and overdose prevention.

Post Partum Support International Magnets & Brochures

100,000 PSI magnets were disseminated this year, totaling 207,760 magnets over the past four years supporting maternal mental health before and after delivery.  In addition, 49,729 patient education Postpartum Support International (PSI) Brochures were printed in English and Spanish for the requesting 45 hospitals and over 50 doulas, along with the previous years totaling 207,760 total PSI Brochures disseminated since 2020.  

Preeclampsia Foundation Blood Pressure Cuff Kits

In 2024, an additional 1,452 Preeclampsia Blood Pressure Cuff Kits were purchased for 27 hospitals to use with at-risk patients, thus totaling 4,661 kits to a total of 34 hospitals to disseminate to pregnant and post-partum women the last four years.  In addition 50 doulas received 4 blood pressure cuff kits to also disseminate to their at-risk patients.  Thanks to a generous grant from the Tennessee Department of Health, Maternal Mortality Review Committee.

AWHONN’s Respectful Maternity Care (RMC) Framework and Toolkit

TIPQC was able to purchase for all BEST FOR ALL teams AWHONN’s RMC Framework and Toolkit which walks teams through implementing the 10 Step “C.A.R.E. P.A.A.T.T.H.” within their organization. Through this toolkit, teams can commit to providing respectful care to “every patient, every interaction, every time!” 

2024 Educational Opportunities

TeamBirth

In May of 2024, TeamBirth’s leadership came to Tennessee to hold two in person sessions on implementing TeamBirth at Tennessee facilities in Nashville and Memphis. This training was open to all interested hospitals, but instrumental in training the five TeamBirth pilot hospitals. Attendees learned the importance of shared decision making and patient centered care. 

Substance Use Disorder Screening & Referral Training

Dr. Jessica Young led a series of trainings throughout the state on treating and referring pregnant women with substance use disorder. Traveling to all five perinatal regions, Dr. Young led attendees through screening for OUD/SUD and Medication Assisted Treatment options for pregnant women with OUD/SUD. 

Cardiac Emergency Department Trainings

Five lunch and learns were held in the perinatal regions across the state to provide over 70 Emergency Department and Obstetric providers with resources for screening, treatment, and referral for OB patients with cardiac concerns. To watch click the link:  training & view the many resources

TIPQC Data Institute

TIPQC hosted the first Severe Maternal Morbidities (SMM) Data Institute on August 29 in Franklin with 100 attendees from 30 hospitals and TDH, and several other interested organizations. Hospital teams were able to learn about SMM, their hospitals’ SMM rate, the AIM Data Center, and how to use this data for improvement from Assistant Commissioner Dr. Elizabeth Harvey, Dr. Danielle Tate, Issac Yi, Tanika Edwards, Sharon Wadley, and Brenda Barker.  Birthing hospitals also received approximately one year of AWHONN POST BIRTH Warning Signs magnets and Post Partum Support International Mental Health Resources to use for patient discharge education. 

Postpartum Support International Training

Over 100 practitioners attended the two day Postpartum Support International (PSI) Perinatal Mood Disorders: Components of Care Certificate of Completion Program and the 66 attended the PSI Perinatal Mental Health Advanced Psychotherapy Training on June 5-7 in Memphis with Dr. Julia Wood, Dr. Kristy Christopher-Holloway, and Birdie Meyers.

For more information please click the link:  Post-Partum Support International

If you need help, call 1.800.944.4773

AWHONN Obstetric Patient Safety: OB Emergencies Workshop

On September 10 and 11, 2024 the HCA SIMS Learning Center hosted the National AWHONN Obstetric Patient Safety: OB Emergencies Workshop 3rd Edition for the first time in Tennessee. The Obstetric Patient Safety (OPS): Obstetric Emergencies Workshop 3rd Edition is designed to help clinicians identify, assess, and manage the care for patients with an obstetric emergency through simulation and debriefing. After this training, Tennessee now has trained instructors!

TIPQC is incredibly grateful to the following hospitals for hosting trainings in 2024:

  1. Ascension Saint Thomas Midtown
  2. Baptist Memorial Hospital – Memphis
  3. Bristol Medical Center
  4. Children’s Hospital at Erlanger
  5. Cookeville Regional Medical Center
  6. Erlanger East Hospital
  7. Holston Medical Group
  8. Maury Regional Medical Center
  9. Methodist University Hospital 
  10. Niswonger Children’s Hospital
  11. Regional One Health
  12. TriStar Centennial Medical Center
  13. University of Tennessee Medical Center, Knoxville
  14. Vanderbilt University Medical Center

Annual Meeting Escape Room SIMS

Thanks to the leadership and expertise of Patti Scott, DNP, and Bonnie Miller, MSN, TIPQC hosted two escape rooms during the Annual Meeting in March. Maternal SIMS included OB Emergencies, hypertension, and hemorrhage.  Infant SIMS covered optimal cord clamping and severe intraventricular hemorrhage.

“You don’t study to pass a test; you study to prepare for the day when YOU are the only thing between the patient and the grave.”  Mark Reid

2024 Quality Improvement Bootcamps

TIPQC hosted two Quality Improvement bootcamps in 2024. The first bootcamp was held in Cookeville on June 13 and was led by Eva Dye, DNP, Dupree Hatch, MD, Emily Morris, MD, and Christa Sala, RRT. It provided a general overview of quality improvement, including general QI tools, run charts, and strategies. All attendees left with a baseline knowledge of quality improvement and how to apply it to their respective systems.

The second QI Bootcamp was held on December 10 in Nashville and was TIPQC’s first-ever “Advanced” Quality Improvement Bootcamp. Thanks to the expertise of Eva Dye, DNP, Dupree Hatch, MD, and Dan France, PhD, MPH, attendees gained a better understanding of QI charts and how to use them to improve their systems. They also gained a deeper understanding of higher reliability interventions and human factors engineering. All attendees enjoyed the training, and one participant wrote, “Great resources and applicable examples. Good foundational information on Human Factors Engineering and designing for high reliability were useful.”

Spinning Babies® Training

TIPQC was delighted to offer 4 more Spinning Babies® workshops in Columbia, Knoxville, Bristol, and Memphis to our maternal leaders throughout the state. Spinning Babies® teaches birth physiology to support fetal rotation and make birth easier for the patient and providers. With over 130 nurses, physicians, doulas and midwives in attendance and representation from more than 50 organizations, TIPQC heard multiple times how this course helped support the work of our Promotion of Vaginal Delivery teams in their efforts to decrease the NTSV cesarean section rate to 23.6%. 

Attendees were eager to share their praise and appreciation for Spinning Babies®:

  • “As a new nurse, I have learned many positions during this class to improve patient outcomes.”
  • “IT WAS AWESOME.”
  • “The trainer at this class is very knowledgeable and shares specific helpful examples for certain scenarios. I feel very educated and confident in applying these concepts in my practice.”
  • “I honestly think this spinning babies class has a lot to do with our success with the PVD project.”  – Kelly Jo Sexton, BSN, RNC-OB, C-EFM, Ballad Health Bristol Regional Medical Center, Clinical Leader

Lactation Workforce Training

TIPQC was asked by United Healthcare and Wellpoint to support Lactation Workforce Training due to the low number of lactation professionals in the state and the new TennCare reimbursement for lactation outpatient visits.  The TIPQC Lactation Taskforce developed a multi-pronged approach including:

  1. Webinar Series: 11 webinars and trainings with 924 attendees and 525 listens to recordings.
  2. Professional Training grants & paying for testing for 8 individuals to train and test to become an International Board-Certified Lactation Consultant (IBCLC).
  3. Professional Training grants for Certified Breastfeeding Specialist (CBS) with 163 individuals receiving the training and the text book.
  4. Professional Training for 49 hospital staff across the state through Lactation Education Resources.
  5. Annual meeting training & workshop with 520 at the plenary session with Dr. Julie Ware and 95 at the Workshop.

“When I say I just shed a few tears of excitement for the scholarship … I am so serious!  Thank you, thank you, thank you!” – Scholarship Recipient

Doula Resource Trainings

Five (5) in-service trainings were held across the state to support over 50 doulas with QI education, cardiac, postpartum depression, and POST BIRTH Warning Signs training and resources. Each doula received four PreEclampsia Blood Pressure Cuff Kits, AWHONN POST BIRTH Warning Signs magnets, and Mental Health Resources through Post Partum Support International.  Door prizes were given in each region of the Breastfeeding Answers Book. The training and resources are valued around $500 per doula.  Looking forward to seeing the impact our doulas will continue to make across the state.

“As a doula dedicated to serving women, it is essential to educate my clients about normal blood pressure ranges, the signs of hypertension, and how to monitor their readings effectively. The blood pressure cuffs have been incredibly valuable, and my clients have expressed appreciation for both the tools and the education they’ve received on their proper use. Thank you for helping me empower my clients with the knowledge and resources to prioritize their health.”  – TN Doula 

“I was at the hospital almost every week with high blood pressure, because my blood pressure cuff wasn’t properly calibrated, and would be different than my OBGYN’s results. With this cuff, the magnets and conversations with my doula, I had a better idea of what to watch for. Once I started getting blurry vision on top of my high blood pressure, I called my doula, and she rushed to get me. Guess what I had … preeclampsia. If I hadn’t been aware of the signs and the ability to check my blood pressure at home, I hate to think about what could have happened.” – BP Cuff Recipient from TIPQC’s Doula Training

National & Statewide Data and Reports

TIPQC is committed to improving outcomes for the pre-pregnancy, pregnancy, and postpartum women in Tennessee through collaborative state and national partnerships.

According to the March of Dimes, Tennessee continues to have poor outcomes for our moms and babies receiving a D- on the Report Card. 

View March of Dimes 2024 Report Card

According to the Maternal Vulnerability Index (MVI), pregnant women in Tennessee have a very high vulnerability to poor outcomes and are most vulnerable due to mental health and substance use. (The MVI is a tool used to understand where pregnant women in each state are more likely to have poor outcomes, including preterm birth and maternal death, due to clinical and other risk factors. Surgo Health, Maternal Vulnerability Index, 2023.)

View Maternal Vulnerability Index (MVI)

TDH Reports

The Tennessee Department of Health recently released the 2024 Maternal Mortality Report, 2024 Birth Defects Report, and 2024 Child Fatality Report.

VIsit TDH Website

Hospitals in TIPQC projects this year:

  1. ASCENSION SAINT THOMAS MIDTOWN
  2. ASCENSION SAINT THOMAS RIVERPARK
  3. ASCENSION SAINT THOMAS RUTHERFORD
  4. BAPTIST MEMORIAL HOSPITAL – TIPTON
  5. BAPTIST MEMORIAL HOSPITAL – UNION CITY
  6. BAPTIST MEMORIAL HOSPITAL FOR WOMEN
  7. BLOUNT MEMORIAL HOSPITAL
  8. BRISTOL REGIONAL MEDICAL CENTER
  9. COOKEVILLE REGIONAL MEDICAL CENTER
  10. CUMBERLAND MEDICAL CENTER
  11. EAST TENNESSEE CHILDREN’S HOSPITAL
  12. ERLANGER EAST HOSPITAL
  13. ERLANGER BARONESS HOSPITAL
  14. FORT SANDERS REGIONAL MEDICAL CENTER
  15. FRANKLIN WOODS COMMUNITY HOSPITAL
  16. GREENEVILLE COMMUNITY HOSPITAL 
  17. HARDIN MEDICAL CENTER
  18. INDIAN PATH COMMUNITY HOSPITAL
  19. JACKSON – MADISON COUNTY GENERAL HOSPITAL
  20. JOHNSON CITY MEDICAL CENTER / NISWONGER CHILDREN’S HOSPITAL
  21. LIVINGSTON REGIONAL HOSPITAL
  22. MAURY REGIONAL MEDICAL CENTER
  23. METHODIST LE BONHEUR GERMANTOWN HOSPITAL
  24. METHODIST MEDICAL CENTER OF OAK RIDGE
  25. MORRISTOWN – HAMBLEN HEALTHCARE SYSTEM
  26. PARKRIDGE EAST HOSPITAL
  27. PARKWEST MEDICAL CENTER 
  28. REGIONAL ONE HEALTH 
  29. RIVERVIEW REGIONAL MEDICAL CENTER
  30. SAINT FRANCIS HOSPITAL – MEMPHIS
  31. SUMNER REGIONAL MEDICAL CENTER
  32. TENNOVA HEALTHCARE CLARKSVILLE
  33. TENNOVA HEALTHCARE NEWPORT MEDICAL CENTER
  34. TENNOVA HEALTHCARE NORTH KNOXVILLE MEDICAL CENTER
  35. TRISTAR CENTENNIAL MEDICAL CENTER
  36. TRISTAR HORIZON MEDICAL CENTER – DICKSON
  37. TRISTAR STONECREST MEDICAL CENTER
  38. UNIVERSITY OF TENNESSEE MEDICAL CENTER
  39. VANDERBILT TULLAHOMA HARTON HOSPITAL
  40. VANDERBILT UNIVERSITY MEDICAL CENTER/MONROE CARELL JR CHILDREN’S HOSPITAL AT VANDERBILT
  41. WEST TENNESSEE HEALTHCARE DYERSBURG HOSPITAL
  42. WEST TENNESSEE HEALTHCARE VOLUNTEER HOSPITAL

Additional Hospitals receiving resources or education include:

  1. METHODIST SOUTH HOSPITAL
  2. NASHVILLE GENERAL HOSPITAL
  3. STARR REGIONAL MEDICAL CENTER
  4. VANDERBILT WILSON COUNTY HOSPITAL
  5. WILLIAMSON MEDICAL CENTER

TIPQC SMM Site Visits

In 2024, TIPQC began conducting site visits starting with five hospitals in Tennessee. TIPQC is eager to meet with additional teams in the coming year. 

Patient & Family Partners

Each hospital is including patient & family partners in their Quality Improvement project teams.  TIPQC provides national training for these critical partners through MoMMA’s Voices.

In addition, TIPQC engages Patient and Family Partners in the State Advisory Council. Each project designates a patient and family partner state leader to advise TIPQC leadership and hospitals across the state.

State Advisory Council:

Rhonda Okoth, MPH, BSN, RN, CCRP, Chair 2024-

Mary Catherine Burke, Chair 2020-2024, NEC Project

Candace Gossett, CLD Project

Kewanna Frierson, BEST for All Project

Lauriane Prior, CCOC Project

Whitney Trotter, CCOC Project 

Bakisha Veal, IVH & CLD Projects

“Working alongside TIPQC as a patient family partner has truly allowed me to share my son’s birth story in hopes of advocating for better outcomes and reducing c-section rates for first time mothers.  Over the course of the vaginal delivery project, I was able to witness other hospital systems across the state incorporate other patient family partners into their projects and use what they learned from our lived experiences to help improve patient care and empower parents to advocate for themselves. Thank you TIPQC for all you do to improve care for moms and babies in Tennessee!” – Rhonda Okoth, MPH, BSN, RN, CCRP

“I love TIPQC and all the great things it does for patients and families!!!” – Deena Kail, BSN, RN, MBA, VP of Operations/CNO, West Tennessee Women’s Center

Community Involvement

TIPQC partners with many dynamic local, state, and national organizations and communities to improve the pregnancy and birthing outcomes for all our Tennessee families. Thank you to our collaborators!

Alliance for Innovation on Maternal Health (AIM)

American Academy of Pediatrics (AAP)

American Board of Pediatrics (ABP) Maintenance of Certification (MOC)

American College of Obstetrics & Gynecology (ACOG, District VII)

Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN)

BlueCare Tennessee

National Network of Perinatal Quality Collaboratives

Postpartum Support International (PSI)

Spinning Babies®

Tennessee Department of Health

Tennessee Hospital Association

UnitedHealthcare Community Plan

Vermont Oxford Network (VON)

Wellpoint

TIPQC’s Community Resource Council

Founded in the Summer of 2024, TIPQC held five Regional Community Resource Council meetings in Memphis, Nashville, Kingsport, Knoxville and Chattanooga. This council aims to gather the perspective and insight of community organizations across the state and incorporate their voices in upcoming Quality Improvement projects. Eighteen organizations joined the council in 2024. TIPQC is excited to watch this council grow, and to continue to engage the community in improving maternal and infant outcomes in Tennessee.

Thank you to the following organizations who hosted the Summer 2024 TIPQC Community Resource Council:

  1. Appleseeds
  2. The Next Door
  3. CADAS
  4. Helping Mamas
  5. NE TN Regional Health Office
    March 25-26, 2024

    Annual Meeting Highlights

    The Annual Meeting was a great success, with relevant and meaningful speakers, workshops, SIMS Escape Rooms, and poster sessions—all inspiring and re-energizing the QI work locally and across the state.  With over 420 joining in, the energy and excitement for the ongoing work, as well as new projects, was palpable.

    Additional State and National Talks

    • Society of Maternal Fetal Medicine, Dr. Connie Graves, February 10-14, 2024
    • Alaska PQC Sustainment Huddle on SUD, Brenda Barker, February 23, 2024
    • NNPQC National Meeting Taskforce, Brenda Barker
    • Missouri PQC Meeting, Dr. Connie Graves, April 17, 2024
    • Perinatal Advisory Committee (PAC) Meeting, Brenda Barker, July 11, 2024
    • Nevada PQC Meeting, Dr. Connie Graves
    • TennCare All Health Plan Meeting, Brenda Barker, September 25, 2024
    • Alabama PQC- IVH, Brenda Barker, September 25
    • Tiny Feet, Big Steps Neonatal Conference, Arusha, Tanzania, Dr. Scott Guthrie presenting work of TIPQC, October 27-30, 2024
    • PAC Meeting, Brenda Barker, October 17, 2024
    • Illinois PQC Annual Meeting, Dr. Rolanda Lister, October 30, 2024
    • Tennessee Department of Health Speaker Series, Brenda Barker, December 18, 2024

    Onward & Upward

    TIPQC is honored to be able to continue to uplift and improve the care for families in Tennessee through strong partnerships, transparent collaboration, and generous funders. We are eager to continue to serve our state in 2025. 

    This project is funded under a Grant Contract with the State of Tennessee to Vanderbilt University Medical Center.