Building a Birth Hospital Learning Community to Prevent Sudden Unexpected Infant Death

Christie Lawrence, DNP, RNC-NIC, APN/CNS
R. Ahadi, MPH
Gina S. Lowell, MD, MPH
Kyran P. Quinlan, MD, MPH

Sudden Unexpected Infant Death (SUID) claims ~ 3,400 infants each year in the United States. In Cook County, IL, a SUID occurs nearly every week and are concentrated in areas that experience increased socio-economic hardship. Birth hospitals rarely hear about the SUID which occur among infants they discharge, contributing to low awareness of the frequency and distribution of SUID in their communities. In 2019, Cook County joined the Center for Disease Control and Prevention’s national SUID surveillance system and through these efforts SUID data by hospital of birth were obtained. In 2023, the Illinois Perinatal Quality Collaborative (ILPQC) named Equity and Safe Sleep for Infants (ESSI) as the statewide QI project for 2024. We describe our process for sharing hospital-specific SUID data and cases with Cook County, IL birth hospitals coinciding with the launch of ESSI.

We identified our Birth Hospital Outreach Coordinator, who leads our hospital’s Safe Sleep Task Force, to drive the outreach approach. Stakeholders were identified at each hospital, and two meetings were scheduled. The first meeting was used to establish relationships, review SUID and the Cook County SUID Case Registry and Prevention (SUID-CR) data, provide hospital-specific SUID rate and ranking among other institutions, and discuss each hospital’s current safe sleep education, modeling, policies and practices. The second meeting reviewed the SUID-CR data process and shared hospital-specific SUID cases, including narratives with doll scene reenactment photos. Stakeholder reflections and opportunities for growth were noted. Follow-up meetings were provided for those stakeholders who desired case-level presentations for staff review. The opportunity for building a learning community was explored. This effort was funded by the Michigan Public Health Institute.

Meetings as described above were completed with 9 hospitals. During this time, 4 other Cook County birth hospitals contacted us for their data and meetings with these hospitals were also completed. Hospital leadership were receptive to and visibly moved by their data, resulting in an openness to sharing their current safe sleep practices and policies. Three hospitals requested presentations to their perinatal and postpartum staff, and these were completed. Common reflections included the importance of raising and sustaining SUID awareness and considerations regarding improved approaches to supporting safe sleep in their perinatal and postpartum settings. The majority of hospitals discussed how ESSI has prioritized improving safe sleep modeling and education, and felt case-sharing influenced how safe sleep education could be optimized to be more conversationally oriented and inclusive.

Providing birth hospitals the details of SUID among their newborn discharges may stimulate a re-examination of how SUID prevention is handled prior to discharge including staff education, safe sleep modeling and crib/bassinet availability for families who need them. Sharing hospital-specific data with birth hospitals as they embarked on ESSI synergistically promoted SUID prevention goals. Reviewing individual SUID cases puts humanity into the statistics allowing hospital personnel to reflect on how they role model and conduct conversations for families they serve.

1. Birth hospitals rarely hear of SUID that occur among the infants they discharged.
2. Sharing hospital-specific SUID data can inform and influence birth hospital safe sleep QI initiatives.
3. Raising awareness through sharing hospital-specific SUID data is a useful approach to improving accurate risk perception of SUID.

Using the Injury Equity Matrix to Surface SUID Prevention Recommendations

Kyran Quinlan, MD, MPH
Felicia Clark, D-ABMDI
Christie Lawrence, DNP, RNC-NIC, APN/CNS
Gina Lowell, MD, MPH

Beginning in July 2023, the Cook County Sudden Unexpected Infant Death (SUID) Case Registry and Prevention team began using a modified Injury Equity Matrix (IEM) tailored to examine SUID. Modifications to the IEM such as including the family’s Social Environment and Belief System, considering factors related to the SUID investigation, and incorporating both parent and infant intersectional identities have facilitated meaningful conversations among team members that have surfaced new ways of thinking about SUID prevention, generated ideas regarding new partnerships, and led to proactive safe sleep approaches for Chicago’s newly arrived migrant population.

This workshop will provide a brief overview of the modified IEM for SUID, and lead participants through the practice of using the IEM for SUID cases. Participants will be broken into 4 groups, each led by one of the presenters, and guided through practice using the modified IEM for 2 cases. Groups will reconvene and discuss the potential prevention recommendations that emerged from this practice. Finally, participants will be challenged to modify the IEM for their own injury prevention topic (e.g. drowning, firearms) and consider who they might engage to regularly review cases using this tool.

1. Become familiar with the components of the Injury Equity Matrix.
2. Practice using the modified IEM to review individual SUID cases.
3. Reflect on how incorporating intersectionality illuminates new prevention approaches.
4. Determine how the IEM could be modified for other childhood injuries.