{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T03:24:28Z","timestamp":1762917868153,"version":"3.44.0"},"reference-count":28,"publisher":"BMJ","issue":"8","funder":[{"name":"Danish Society for Patient Safety"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2017,12,5]]},"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>A safe delivery is part of a good start in life, and a continuous focus on preventing harm during delivery is crucial, even in settings with a good safety record. In January 2013, the labour unit at Copenhagen University Hospital, Hvidovre, undertook a quality improvement (QI) project to prevent asphyxia and reduced the percentage of newborns with asphyxia by 48%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The change theory consisted of two primary elements: (1) the clinical content, including three clinical bundles of evidence-based care, a \u2018delivery bundle\u2019, an \u2018oxytocin bundle\u2019 and a \u2018vacuum extraction bundle\u2019; (2) an implementation theory, including improving skills in interpretation of cardiotocography, use of QI methods and participation in a national learning network. The Model for Improvement and Deming\u2019s system of profound knowledge were used as a methodological framework. Data on compliance with the care bundles and the number of deliveries between newborns with asphyxia (Apgar\u2009&lt;7 after 5\u2009min or pH\u2009&lt;7) were analysed using statistical process control.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Compliance with all three clinical care bundles improved to 95% or more, and the percentages of newborns with pH\u2009&lt;7\u2009and Apgar\u2009&lt;7 after 5\u2009min were reduced by 48% and 31%, respectively. In general, the QI approach strengthened multidisciplinary teamwork, systematised workflow and structured communication around the deliveries. Changes included making a standard memo in the medical record, the use of a bedside whiteboard, bedside handovers, shared decisions with a peer when using an oxytocin infusion and the use of a checklist before vacuum extractions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This QI project illustrates how aspects of patient safety, such as the prevention of asphyxia, can be improved using QI methods to more reliably implement best practice, even in high-performing systems.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2017-006599","type":"journal-article","created":{"date-parts":[[2018,2,3]],"date-time":"2018-02-03T12:15:13Z","timestamp":1517660113000},"page":"633-642","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Successfully reducing newborn asphyxia in the labour unit in a large academic medical centre: a quality improvement project using statistical process control"],"prefix":"10.1136","volume":"27","author":[{"given":"Rikke von Benzon","family":"Hollesen","sequence":"first","affiliation":[{"name":"Danish Society for Patient Safety, Frederiksberg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rie Laurine Rosenthal","family":"Johansen","sequence":"additional","affiliation":[{"name":"Danish Society for Patient Safety, Frederiksberg, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"R\u00f8rbye","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise","family":"Munk","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Barker","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Improvement, Cambridge, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anette","family":"Kjaerbye-Thygesen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,2,3]]},"reference":[{"key":"2025090412402493000_27.8.633.1","unstructured":"Committee Euro-Peristat. 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