2021 Annual Report
Greetings from Our Leaders
Lisa Piercey, MD, MBA, FAAP
Commissioner of the Tennessee Department of Health
Tobi Amosun, MD, FAAP
Assistant Commissioner of the Tennessee Department of Health Division of Family Health and Wellness
Jona Bandyopadhyay, MD, MPH, FACOG
Susan Guttentag, MD
Scott Guthrie, MD
TIPQC Infant Medical Director
Jessica Young, MD, MPH
TIPQC Maternal Medical Director
Danielle Tate, MD, FACOG
TIPQC Maternal Medical Director Elect
Rolanda Lister, MD
TIPQC Officer for Health Equity
Patti Scott, DNP, APN, NNP-BC, C-NPT
TIPQC Infant Quality Improvement Specialist
Bonnie Miller, RN, MSN
TIPQC Maternal Quality Improvement Specialist
Mike DeVoe, MD
TIPQC State Project Leader
Courtney Gutman, MD
TIPQC State Project Leader
The Oversight Committee is critical to the work of TIPQC. Special thanks and much gratitude for your contribution to improved care for mothers and infants in Tennessee.
- Brittnea Adcock, DO
- Tobi Amosun, MD, FAAP
- Jona Bandyopadhyay, MD, MPH
- Kelly Bennett, MD
- Joel Bradley, MD, FAAP
- John Buchheit, MD
- Mary Catherine Burke, DMCP
- Tara Burnett, MD
- Greg Canella, MD
- Chris Clarke, RN
- Melissa Davis, DNP, CNM, FNP
- Mike DeVoe, MD
- Cornelia Graves, MD, FACOG
- Susan Guttentag, MD, Chair
- Brian Hackett, MD, PhD
- Jeanne James, MD, FAAP
- Joseph Kipikasa, MD
- Morgan McDonald, MD, FACP, FAAP
- Diana Moses, RN, BSN, MBA
- Ajay Talati, MD
- Danielle Tate, MD, MBA
- Kevin Visconti, MD
- Lynlee Wolfe, MD
- Victor Wu, MD, MPH
- Brenda Barker, MEd, MBA
- Reddy Dhanireddy, MD
- Scott Guthrie, MD
- Anna Morad, MD
- Jessica Young, MD, MPH
- Nikki Zite, MD, MPH
- Kitty Cashion, RN-BC, MSN
- Marlee Crankshaw, DNP, RN, CNML
- Melanie Ford, RNC
- Deena Kail, BSN, RN, MBA
Maintenance of Certification (MOC) Committee
- Tara Burnette, MD
- Donna Whitney, MD
“It’s been a career highlight to see and help the organization grow since our first meeting years ago. Thanks to all of the incredible paid and volunteer staff along the way, truly a group effort. Nice to see TIPQC is a now recognized resource to others throughout the state and region.”W. Michael DeVoe, MD
“Thank you! It has been an honor to serve in a small way for this organization that I truly believe has had an enormous impact in our state.”John Buchheit, MD
TIPQC Operations Staff
Staff bios and details are available on our website.
2021 in Pictures
March of Dimes Report Card
Year in Review
The Importance of Parent Engagement
by Mary Catherine Tagg Burke
Every NICU parent remembers admission day! It is a new environment with new sounds, small babies, that might be your own, and a completely new care team with a medical language you have to learn.
Thank you to all the patients and families who have shared their stories to help us improve the care for all Tennessee Moms & Babies!
Opioid Use Disorder (OUD) and Opioid Exposed Newborn (OEN) Wave 1 Projects
After two years of work, this project went into sustainment at the end of 2020, with final data entry January 2021. Thirteen (13) OUD teams reviewed 3178 charts for 1100 Women. The OEN project had 15 teams caring for 1188 babies. Congratulations to all the hospital teams making terrific improvements in the middle of a pandemic.
“The effort and dedication during a pandemic are exemplary. We look forward to the next round of data. Let us know if there is anything more we can do as a partner to show our appreciation and encouragement to the participants and to their hospital leadership as well.”Joel Bradley, MD, United HealthCare
This project made possible by a generous grant from United HealthCare.
For highlights, please see the Wave 1 Impact Statements:
“I feel blessed for our hospital to be recognized, we are doing better on this project already.”
“Our staff is totally maxed out between COVID and an extremely high census. We have achieved several GOLD level wins and are happy to announce that to the staff (upon learning of their Gold Status Award). We can all use some good news! Thanks for all your hard work and support for all the teams across the state. I know this is no small task and hope you realize the number of lives you are helping!”
FOCUS on Health Equity
Every project TIPQC does has racial and ethnic data. We continue to focus and shine a spotlight on disparities. At least 25% of content in the podcasts are directly relevant to topics that impact the maternal and neonatal health in our communities of color.
Healthy Mom Healthy Baby Tennessee Podcast
Podcasts were made available through an initial grant from ACOG AIM.
Over 520 physicians, nurses, healthcare workers and other stakeholders, attended the virtual TIPQC Annual Meeting featuring three days of talks around QI projects, health disparities, and COVID-19.
All talks were recorded and can be accessed through the website along with the full list of topics and speakers.
Quality Improvement Awards were given to teams across the state.
Association of Women’s Health, Obstetrics & Neonatal (AWHONN) POST-BIRTH WARNING SIGNS
POST-BIRTH women are at risk for potential life-threatening medical complications that can occur after hospital discharge. TIPQC was able to provide national training through AWHONN allowing 10 Learning Seats for each of 46 hospitals resulting in 4,600 hours of nursing education to address these warning signs and educate patients. In addition to the handout in English, Spanish, Arabic and Chinese, TIPQC purchased 84,800 (refrigerator) magnets for hospitals to disseminate to all postpartum moms.
“We are extremely grateful for the opportunity to have these trainings available. Thank you so much!”Jennifer Rhoades, BSN, RNC-OB, C-EFM, IBCLC, Centennial Medical Center
“Two weeks following the training, one doula reported a successful clinical case as a testament to adequate training and knowledge growth due to the training session. The doula’s client was one week postpartum complicated by gestational diabetes mellitus. The client contacted her doula regarding persistent headaches that failed to resolve with over-the-counter medication. The doula reported that due to the educational training on postpartum warning signs, and the elevated risk of preeclampsia due to GDM, she recognized that this constituted a reason for her client to present to the hospital for urgent care. When the patient went to the hospital, she was diagnosed with postpartum preeclampsia with severe features and appropriately treated.”
This training was made possible through a grant from the American College of Obstetricians & Gynecologists (ACOG) Alliance for Innovation on Maternal Health (AIM) and Tennessee Department of Health (TDH) Maternal Mortality Review (MMR) to implement the tool kit and POST-BIRTH patient education in discharge planning.
National Preeclampsia Foundation Blood Pressure Cuff Project
TIPQC joined the National Preeclampsia Foundation’s Remote Monitoring Research Project, purchasing 2,164 Blood Pressure Cuffs for all Hypertension project teams to disseminate to at-risk women.
Through this research project, the Preeclampsia Foundation reported 93% of the hospitals distributing the blood pressure cuffs across the United States believed the cuffs influenced patient care.
In addition, thanks to a grant from United HealthCare, TIPQC is piloting BabyScripts at Regional One Health. This two year project utilizes a patient app which interacts with the hospital Electronic Health Record (EHR) and links home blood pressure readings to providers.
What our pregnant and postpartum moms are saying….
“I am so grateful to be able to check my blood pressure at home. It has been really nice to have that peace of mind.”
“I really like having a cuff. It has been really helpful. I think it is a really good idea.”
“It has been really great to be able to check my blood pressure, especially when I feel like it may be high – it is nice to check it right away at home.”
“Being able to take my blood pressure at home is so convenient, especially so I can keep my twin babies home. I do not have to go into a place with them during COVID.”
“The addition of the BabyScripts pilot program has tremendously aided our providers in patient care and given our patients access to health promotion resources we’ve not been able to provide in the past. The ability to inform and manage in this innovative way has been very exciting and effective.”Danielle Tate, MD, MBA, Regional One Health, Memphis
TIPQC Simulation Trainings
This project provided education and simulation training through a train the trainer model. One hundred forty-one (141) attended the training from 49 hospitals in Nashville on June 22-24, 2021. Five additional hospital teams were unable to attend. In all 54 hospitals received training, MamaNatalie & NeoNatalie, supplies, curriculum, & resources–a $6000 value. Three training videos are available online with free CME for hospital teams to use as well as the opportunity for the TIPQC Faculty to do site visits in the Fall of 2021 to support the local hospital SIMS teams.
“We want all of our birthing hospitals to be prepared to deal with difficult problems whether that is with the mother or the baby. One of the best ways to do this is with simulation. We want to give the tools and the training needed to help every hospital in Tennessee be ready when one of these tough situations comes through the door.”Scott Guthrie, MD, Infant Medical Director for TIPQC
“Simulation training has proven to be beneficial in improving outcomes of high-risk pregnancy conditions. Standardization of treatment and protocols has been shown to decrease maternal mortality and morbidity in all patients with the largest improvement in outcomes in women of color. United HealthCare’s decision to support a statewide simulation effort means that we can improve care for all pregnancies across the state of Tennessee and decrease disparities for both mothers and babies.”Connie Graves, MD, Statewide Project Co-leader
“This has been the most engaging education opportunity I have ever been involved in and I am so excited to implement what I have learned.”
“There are no words for how this helps small, rural hospitals with limited resources!“
The TIPQC SIMS faculty completed a site visit at Fort Sanders Regional Medical Center, and a mere 45 minutes after leaving the training, a hemorrhage totaling 1,250ml of blood loss occurred. Elisabeth Torrent, Women’s Service Education Coordinator, stated, “…everything ended well, and our new team members said that the SIMS really helped them understand what they needed to do!”
The Speakers Bureau continued this year with six (6) hours of additional training from Matt Moran. An additional talk on maternal mental health was also added to the other five talks: Maternal Hemorrhage, Maternal HTN, Safe to Sleep, Opioid Use Disorder, Opioid Exposed Newborn, & Health Equity. These talks are available at no charge to hospitals, community groups, and other educational meetings. A total of 28 presentations were given in 2021 to 1058 participants.
Three of the talks were filmed: Maternal Hypertension with Danielle Tate, MD, Maternal Hemorrhage with Connie Graves, MD, and Perinatal Mood Disorders with Julia Wood, MD, and are available online with CME credits.
The journal article describing the speakers bureau titled “Implementing a Statewide Maternal Speakers Bureau Addressing Maternal Morbidity & Mortality” has been accepted for publication in the Nursing for Women’s Health, to be released Spring 2022.
The speakers bureau was made possible through a grant from the Tennessee Department of Health (TDH) Maternal Mortality Review (MMR).
TIPQC hosted six (6) monthly Vaccine Series highlighting COVID and non-COVID vaccinations in pregnant women & children, with over 300 attendees. Talks are available on the website along with an infographic.
“That was a great lecture with practical take home tools to use ‘in the field’ to help increase vaccination rates and build trust with families! Thanks for sponsoring the series!!”Donna Whitney, MD, Maury Regional Medical Center
Maternal Mental Health Resources
Maternal Mental Health continues to be one of the top contributing factors identified in the Maternal Mortality Review. “Almost half (47%) of all pregnancy-associated, but not related deaths with substance use disorder had a co-occurring mental health diagnosis as a contributing factor to death.”
At the 2021 Annual TIPQC Meeting, maternal mental health was identified as a top concern. TIPQC has CME videos available at no charge, including one on Perinatal Mood and Anxiety Disorders as well as a recorded talk at the 2021 Annual Meeting by Dr. Julia Wood.
TIPQC has been able to partner with Postpartum Support International (PSI) Tennessee chapter to:
- Print 106,935 magnets and brochures for 45 birthing hospitals in Spanish and English to distribute to every birthing person, highlighting the HELPLINE, as well as additional resources/supports available
- Offer the PSI certificate training- at no charge- for providers in 2022 (watch for more info!)
- Add a maternal mental health speaker’s talk to the speaker bureau
- Feature PSI resources in discharge planning with our OUD OEN Wave 2 Project
Severe Maternal Hypertension
Fifteen (15) hospital teams have been participating in this project over the past year. The pilot teams have been able to improve by 56% the timely treatment of severe hypertension under 60 minutes. The additional statewide teams have also improved their timely treatment by 78%.
The Learning Session in August 2021 had over 80 attendees from 16 hospitals with speakers addressing the patient perspective, the California CMQCC Journey, and Methodist South and Blount sharing resources & successes. Racial Disparities were addressed.
Safe to Sleep Project
Thirteen (13) teams worked for over a year and a half, auditing over 3100 infants, in order to model and educate safe sleep to parents and caregivers in the hospital setting. A significant improvement of 22% was noted in the percent of audits compliant with the AAP guidelines. Unsafe bedding remains a top reason for non-compliance. This project went into sustainment after the Closing Learning Session on August 3, 2021 with 90 attendees, celebrating the work of the teams! Teams received banners for their hospitals, shared their work in the poster session, and discussed sustainment. A Sustainment Huddle was held in November 2021, and teams continue making improvements, monitoring infant sleep, as well as providing education, and community outreach. American Board of Pediatrics (ABP) Maintenance of Certification (MOC) was received for any participating physician.
“Congratulations to all the teams helping each infant in Tennessee to reach their first birthday!“
“Thank you and the team so much for this opportunity! It has been a great learning experience and such a gratifying project!!!!!”Elishia Gifford BSN, RN, Ascension St. Thomas
Wave 2 Opioid Use Disorder (OUD) and Opioid Exposed Newborn (OEN) Project
Seven (7) joint maternal & infant hospital QI teams began working on this project January 1, 2021 and went into sustainment December 31, 2021, with final data capture January 31, 2022.
During the Wave 2 project time frame, data was captured on 517 OUD-OENs dyads. In addition, 1519 randomly sampled delivery charts were reviewed by the participating hospital teams. A 42% improvement was seen in pregnant woman being screened for SUD using a validated screening tool. In addition, over 90% of OENS discharged received a referral to a Pediatric developmental clinic/specialist.
Learning Sessions and monthly huddles supported sharing and education. The June 8, 2021 Learning Session was attended by 86 teams and individuals from 20 hospitals and 6 community groups focused on Discharge Planning Resources: Community Health Access and Navigation in Tennessee (CHANT), Tennessee Early Intervention System (TEIS), Hepatitis C Follow Up, AWHONN POST-BIRTH Warning Signs, PSI, and Strongwell. A patient’s story was also highlighted including racial disparities in OUD treatment. The September 14, 2021 Learning Session with over 55 attendees featured a Peer Recovery Coach, as well as information on Opioid Toxicology, Overdose Epidemic, TennCare & Managed Care Organizations (MCO) Services, Department of Children’s Services (DCS) Updates, Neonatal Touch & Massage, and project data.
“This dyad project was the hardest so far to grasp and get done as it was so broad (mothers, babies, inpatient across 3 units and outpatient)!! Thanks for your leadership and support to get this accomplished!”Tara Burnett, MD, University of Tennessee Medical Center, Knoxville
TIPQC received the statewide “Excellence in Service Award” from One Tennessee, May 2021, for this project.
Additional Resources offered across the State:
TIPQC selected and sponsored 55 nurses & therapists from 22 hospitals to attend the Neonatal Touch Massage Certification Training.
“I was so fortunate to have TIPQC pay for me to attend the Neonatal Touch & Massage Certification course. As a working mom, TIPQC’s financial contribution is so greatly appreciated. I learned SO much and hope to implement many of the learned objectives within our unit. TIPQC and their initiatives have done so much for our babies and we are so thankful.”Alanna Ferguson Britton, MS, CCC-SLP, Methodist Germantown Hospital
“THANK YOU SO VERY MUCH for this course! I have considered this course for years, and I am so grateful to TIPQC! I think EVERYONE that works in the NICU needs this course. I LOVED the practical approaches to developmental care. I also loved the extensive research behind everything taught. The most impressive point for me was learning more about what we do, and how we touch and support the brains growing in our NICU, really matters!”Karen Speropulos, Niswonger Children’s Hospital
Community Resources Webinar to address Social Determinants of Health & Screenings
Navigating the resources for patients and families during COVID has been particularly challenging. This webinar was presented in conjunction with TN ACOG and TN American Academy of Pediatrics (AAP) to over 100 health care professional to better equip them to address food and housing insecurities in our state.
Trauma Informed Care Workshop – October 5, 2021
Almost 100 attendees joined Becky Haas to learn more about the impact of trauma on our patients, and how to provide better care with a greater understanding of Adverse Childhood Experiences (ACES) and trauma.
“Our staff was raving about this training.”
In coordination with the Florida PQC, two presentations were developed and filmed for buprenorphine x-waiver training for practitioners, followed by a webinar in January 2022. All have free CME credit available.
“Dr. Young is gifted at describing the big picture and step by step instruction and hits on all issues—including ‘tangibles.’ These trainings are perfect.”Pam Carbiener, MD, Florida PQC
Tennessee receives Vermont-Oxford NAS State of Excellence in Education & Training Award
TIPQC partnered with Vermont Oxford Network to offer all TN hospitals the Universal NAS Training, thus improving the quality and safety of care for OEN & NAS infants. Center of Excellence in NAS Education and Training was awarded to 26 hospitals who successfully trained their core team through the entire curriculum of 18 micro-lessons.
19,997 Modules were completed by 2,277 learners in 39 hospitals, with 26 hospitals receiving Center of Excellence status.
“This was so great and reflective of the significant work on behalf of TIPQC and participating hospitals and practices. Congratulations.”Morgan McDonald, MD, FACP, FAAP, Deputy Commissioner, Tennessee Department of Health
“Congratulations, TIPQC team! And to TDH and TennCare for the longstanding support of TIPQC—great example of how a state can move the needle on important perinatal work!”Michael D. Warren, MD, MPH, FAAP, Associate Administrator of the Maternal and Child Health Bureau (MCHB), U.S. Department of Health and Human Services
Projects in Development for 2022
OCC Development Stage:
Faculty has developed project; received IRB approval; pilot teams meeting; Spring 2022 statewide enrollment
TTB Development Stage:
Recruiting faculty to begin development
PVD Development Stage:
Faculty is beginning development of the project, including tool kit, AIM requirements
Across the State and Nation
TIPQC is frequently asked to share the work our teams are doing across Tennessee and the United States.
- Danielle Tate – Nashville Fetal & Infant Mortality Review Meeting
- Brenda Barker – State Maternal Mortality Review Meeting
- Brenda Barker – National Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative (OMNI) Association of State & Territorial Health Officials (ASTHO) Summit
- Brenda Barker – The Association of Infant Mental Health in Tennessee (AIMHiTN) Conference
- Anna Morad – TDH Perinatal Advisory Committee (PAC) Meeting
- Jessica Young – One Tennessee State Summit
- Courtney Gutman – TDH Safe Sleep Conference
- Jessica Young – PAC Meeting
- Jessica Young – ASTHO Omni Close out meeting
- Scott Guthrie – Institute for Healthcare Improvement National Maternal Sprint
- Cornelia Graves – interviewed by WNBJ-TV
- Brenda Barker – National ACOG AIM State Leaders
- Brenda Barker – National Network of Perinatal Quality Collaboratives Leaders (NNPQC)
- Rolanda Lister, Scott Guthrie, Terri Scott, Jessica Young, Danielle Tate – IHI Breakthrough Series
- Brenda Barker & Ashley Lerro, Vermont Oxford Network (VON) Virtual Meeting
- Brenda Barker – PAC Meeting
- TIPQC Nutrition Project: Hospital Pediatrics publication (Hosp Pediatr (2022) 12 (2): 173–181.
- Hospital Pediatrics mention of TIPQC PPLARC project
- “Implementing a Statewide Maternal Speakers Bureau Addressing Maternal Morbidity & Mortality” has been accepted for publication in the Nursing for Women’s Health, to be published Spring 2022.