First Comes Baby

Indiana hospitals join forces to reduce infant mortality

A child’s first birthday is a momentous occasion. Parties are planned, cakes are baked, and friends and family members gather to celebrate the past year and welcome the years to come. Unfortunately, far too many babies in Indiana don’t reach that milestone.

In 2016, 623 Hoosier babies died before they reached their first birthday. One baby dies every 13 hours in Indiana, making our state 42nd in the nation for infant mortality.

In January, Gov. Eric Holcomb made reducing the state’s infant mortality rate a priority when he announced his intent for Indiana to be the best state in the Midwest for infant mortality rates by 2024. Indiana hospitals applauded this ambitious goal. They know that the infant mortality rate is a reflection of the state of maternal health and the quality and accessibility of care for women and infants. And they know that improving birth outcomes is critical to improving the overall health of women and babies across the state.

Hoosier hospitals had been working toward reducing infant mortality long before Holcomb made his announcement. Key among their efforts is the implementation of hospital safe sleep practices. Infant deaths due to unsafe sleep practices are 100 percent preventable. In partnership with IHA, Indiana hospitals are focused on reducing these preventable deaths and doing their part to ensure more babies make it to their first birthday—and beyond.


Sudden unexplained infant deaths (SUIDs) accounted for 14.4 percent of infant deaths in 2014. The majority of these deaths were due to sudden infant death syndrome (SIDS) or accidental suffocation/strangulation in bed. Recognizing the severity of the situation, in 2015 the Quality Improvement Committee of the Indiana Perinatal Quality Improvement Collaborative (IPQIC) began exploring how hospitals could help reduce these accidental deaths.

“Hospitals are an important touch point for families and communities,” said Annette Handy, RN, clinical director of quality and patient safety at IHA and co-chair of the IPQIC Quality Improvement Committee. “We realized that by standardizing their messaging and implementing hospital safe sleep practices, Indiana hospitals could help educate parents and families on the importance of safe sleep and ultimately influence a reduction in the state’s infant mortality rate.”

The Quality Improvement Committee surveyed Indiana’s 90 birthing hospitals in August 2015 and created the QI Subcommittee on Reducing SUID in Indiana. The subcommittee then reviewed available data, survey results, current efforts, and related literature to develop recommended hospital safe sleep practices, which were approved by the IPQIC Governing Council in May 2016. These practices include safe sleep policy adoption, staff development to model safe sleep practices with consistent messaging, staff practice compliance audits, awareness of local safe sleep distribution sites, and voluntary certification through the Cribs for Kids® National Hospital Certification Program.

In December 2016, IHA received a grant through the Indiana State Department of Health’s Safety PIN (Protecting Indiana’s Newborns) program. The quality and patient safety team quickly realized this was an opportunity to encourage Indiana hospitals to implement IQPIC’s hospital safe sleep practices and support them in their efforts.

“There are a number of other Safety PIN grant awardees who are taking a regional approach to their efforts,” Handy said. “Ours is the only one that is statewide.”

To help ensure success, IHA deliberately rolled out the project in stages through the state’s 11 regional patient safety coalitions. As of October 2018, the work has been introduced in 10 of the regions; the final coalition will join the project by the end of the year.

Participating hospitals receive a number of tools to help them in their efforts, including a safe sleep road map, pop-up banner, and templates for staff development. A new newsletter serves to share best practices and highlight hospitals that have made significant progress.

While it’s too early to determine the impact of the Safety PIN work on Indiana’s infant mortality rate, there’s one measurable statistic that speaks to the project’s success so far: The number of Indiana hospitals that have achieved Cribs for Kids certification has tripled since the project began in January 2017.

“We’re proud of our hospital partners and understand they have competing priorities,” Handy said. “We feel privileged to walk along this path with them as they work to save the lives of babies in their own neighborhoods.”

The ultimate goal of the project is clear: By Dec. 31, 2020, 100 percent of Indiana birthing hospitals will adopt the IPQIC’s hospital practice safe sleep recommendations. Hospitals looking to become more engaged in the work are encouraged to contact IHA.

“Every baby deserves to celebrate his or her first birthday. We invite Indiana hospitals to join us in creating a highly reliable statewide system by modeling safe infant sleep and developing strategies to educate and connect with their neighbors to ensure that no Hoosier family suffers the 100 percent preventable death of an infant due to accidental suffocation or strangulation,” Handy said. “With focused attention on preventable risks and ensuring a healthy start, Indiana hospitals will aid in our achieving the call from Governor Holcomb for Indiana to have the lowest infant mortality rate in the Midwest by 2024.”


While IHA leads statewide efforts to reduce infant mortality, the patient safety coalitions are working at the regional level. The Northwest Indiana Patient Safety Coalition (NWIPSC) was the first coalition IHA engaged in the Safety PIN grant work. The region desperately needed the extra assistance, according to Mary Puntillo, RN, neonatal nurse clinician at Community Hospital in Munster.

“When we looked at the statistics, we realized we were in a region that does poorly in comparison to the rest of the state. And of course, the state already does poorly in comparison to the rest of the nation,” Puntillo said. “One ZIP code in Lake County in particular had one of the worst infant mortality rates in the state.”

Puntillo, who had been teaching safe sleep practices at her infant safety classes for parents at Community Hospital, was a natural fit to lead the NWI Infant Safe Sleep Work Group, a  subcommittee of the NWIPSC. She reached out to her peers at the other area hospitals, and the group began discussing the possibility of working together toward achieving Cribs for Kids certification.

“We had already been working on gathering data the Indiana State Department of Health was trying to capture regarding infant mortality, so this tied in nicely,” Puntillo said. “It brought us all to the table and kept everyone motivated. We couldn’t drop the ball; we had to keep tossing it around.”

Many of the hospitals had considered seeking Cribs for Kids certification in the past, but they had not been able to prioritize the effort. Through the work group, they were able to do so. Members met regularly by phone to see how everyone was progressing and if there were any concerns. The constant contact was key to keeping everything moving forward, Puntillo noted.

“You didn’t want to be the one holding things up,” she said.

While progress was slow in the beginning, each hospital was determined to demonstrate its commitment to infant safe sleep.

“No one wanted to settle for bronze-level certification,” Puntillo said. “We all wanted to shoot for the gold.”

Puntillo noted that the certification process was educational for both families and caregivers—including herself.

“I originally thought it was most important for us to educate families about safe sleep practices while the infant was in the hospital. In fact, it’s more important for us to educate them before the baby is born,” she said. “Parents are buying unsafe products while they get their nursery ready and receiving them as gifts at baby showers. They need to know that just because something is in the store doesn’t mean it’s safe.”

Overall, families are responding positively to what they’re learning, Puntillo noted, although she said some family members are resistant to the message.

“One grandmother had spent a small fortune on customized embroidered bumpers for her grandson’s crib. ‘What do I do with them now?’ she asked me,” Puntillo said. “I get it. It can be frustrating. But we can’t say that what we thought was safe yesterday is safe today because now we know better.”

The hospitals’ commitment paid off. Every hospital in the region has achieved certification at either the gold or silver level: Community Hospital, St. Catherine Hospital, St. Mary Medical Center, Franciscan Health Crown Point, Methodist Hospitals’ Northlake Campus, and Methodist Hospitals’ Southlake Campus attained gold-level certification, while Franciscan Health Dyer, Franciscan Health Hammond, and Franciscan Health Michigan City attained silver-level certification. While each hospital received its certification at a different time, they all announced the achievement at once, having agreed to wait until they could release a joint statement.

“We essentially linked arms and came out together with the common message that our babies need to sleep safely,” Puntillo said. “Competition is not on the table. Patient safety is. It’s all about keeping the baby safe.”

If you have any questions or would like further details regarding this project, please contact Annette Handy, clinical director, at