SUID: Better Data = Better Interventions

Introduction

This document summarizes the key points and discussions from the final presentation in the "Teaming Up for Safe Sleep" webinar series, delivered by Dr. Rachel Moon. The webinar centered on the crucial role of data from child death reviews in informing and enhancing interventions aimed at reducing Sudden Unexpected Infant Death (SUID) within pediatricians' practices, Child Fatality Review Teams (CFRTs), and communities. The initiative was a collaborative effort funded by a joint grant from the American Academy of Pediatrics, the Texas Pediatric Society, and the Isabelle Davis Center, which is a partnership between Baylor College of Medicine and Texas Children's Hospital. The primary objectives were to foster better collaboration and engagement between pediatricians and CFRTs, to leverage child death review data for educational purposes directed at healthcare providers and the public, and ultimately to guide and improve SUID prevention strategies.

Key Focus Areas

Dr. Moon's presentation emphasized the pivotal role of CFR/CDR data in achieving these objectives through three main avenues:

• Improving Conversations with Families about Safe Sleep: Utilizing local, evidence-based data to enhance the impact and effectiveness of safe sleep recommendations and address parental concerns proactively.
• Implementing Quality Improvement (QI) Projects in Healthcare Settings: Employing root cause analysis, informed by CFR data, to identify systemic issues and develop targeted interventions aimed at improving infant safety protocols.
• Advocating for Infant Safety at Local, State, and National Levels: Leveraging CFR data to support policy changes, regulations, and community-based initiatives designed to reduce preventable infant deaths.

Utilizing CFR Data to Enhance Family Education

Dr. Moon highlighted that while healthcare providers are considered trustworthy sources of information by parents, a concerning statistic from the CDC reveals that only 55% of parents receive correct safe sleep advice from their healthcare providers. This underscores the need for more effective communication strategies. To this end, Dr. Moon advocated for the use of local CFR data to make the risks associated with unsafe sleep practices more tangible and personally relevant for parents. By presenting data that reflects the experiences within their own community, healthcare providers can strengthen their recommendations and increase parental adherence to safe sleep guidelines. Dr. Moon also presented a flowchart illustrating the complex process by which parents make decisions regarding infant care, emphasizing the multiple points at which healthcare providers can intervene with accurate and consistent information to influence those decisions positively.

Implementing Data-Driven Quality Improvement Projects

The presentation introduced the concept of root cause analysis as a valuable tool for quality improvement. This systematic process, originally developed by Toyota, involves using data to understand the underlying causes of problems, rather than just addressing the symptoms. In the context of SUID prevention, root cause analysis utilizes CFR data to identify factors contributing to infant deaths, prompting healthcare teams to ask "why" repeatedly to uncover the fundamental issues. Dr. Moon provided examples of successful QI projects, including initiatives focused on improving documentation of safe sleep counseling at hospital discharge and in well-child visits, as well as efforts to modify inpatient practices related to crib safety (e.g., ensuring empty cribs, appropriate positioning) and preventing bed-sharing. The AAP's upcoming QI module on safe sleep was also mentioned as a valuable resource for healthcare professionals.

Advocacy for Infant Safety Using CFR Data

Dr. Moon presented several impactful real-world examples demonstrating how CFR data has been instrumental in advocating for infant safety:

• MedStar Franklin Square Hospital (Baltimore County, Maryland): By treating each SUID case as a sentinel event and informing the birth hospital of the death and associated unsafe sleep factors, they prompted a review of hospital procedures and education, leading to a significant reduction (over 50%) in the county's infant mortality rate.
• Baltimore City's "Be More for Healthy Babies" Program: This program, initiated in response to alarming CFR data revealing a high infant mortality rate and significant racial disparities largely attributed to bed-sharing, implemented a comprehensive public health campaign. This included a website with safe sleep information, access to free portable cribs, a 24-hour parent hotline, and smoking cessation support. The program achieved a substantial decrease in infant mortality, sleep-related deaths, and the black-white disparity in infant mortality.
• Cribs for Kids: Founded based on Pennsylvania CFR data highlighting that infant deaths were concentrated in low-income neighborhoods, disproportionately affected Black families, and often involved unsafe sleeping environments, this organization has distributed nearly one million cribs and provided safe sleep education since 1998.
• Legislative and Recommendation Changes: CFR data has directly contributed to significant policy changes and safe sleep recommendations. For instance, data on the risks of inclined sleepers, combined with biomechanical data, led to the Safe Sleep for Babies Act, which banned their sale and distribution. Similarly, CFR data highlighting the extreme risks associated with infants sleeping on couches, sofas, and armchairs led to a specific recommendation against this practice. Furthermore, data indicating the dangers of soft bedding for rolling infants informed the recommendation to keep cribs empty except for the baby.

Innovative Outreach and Collaborative Partnerships

The webinar also explored innovative methods for disseminating safe sleep messages, including utilizing social media platforms like TikTok. While acknowledging the challenges of achieving widespread reach, Dr. Moon suggested learning from initiatives by organizations like NICHD. The importance of funding for these outreach efforts was discussed, with suggestions to seek support from public health agencies, the AAP, and private donors by presenting data-backed justifications for program effectiveness.

Engaging parents who have experienced infant loss to share their personal stories was highlighted as a powerful means of conveying the importance of safe sleep practices. Building strong partnerships with community organizations such as local chapters of Cribs for Kids and First Candle, as well as parent-led support groups, is crucial for expanding reach and impact. Within local healthcare systems, collaboration with injury prevention coordinators and leveraging professional networks like the AAP can further strengthen community-based interventions.

Legislative and Regulatory Advocacy

Dr. Moon provided insights into effective strategies for advocating for policy changes at the legislative level. Focusing on product safety issues, such as advocating for bans on inherently unsafe products like inclined sleepers and bumper pads, tends to be a successful avenue. Collaborating closely with organizations like the AAP and the Consumer Product Safety Commission (CPSC) is essential for developing sound legislative language and effectively advocating for these crucial changes. Dr. Moon noted the AAP's recent successes in achieving legislative bans on inclined sleepers and bumper pads, as well as CPSC's mandatory standards for nursing pillows and infant support cushions.

Conclusion

Dr. Moon concluded by emphasizing the vital role of active engagement with local CFR teams and the strategic utilization of available data and resources. By leveraging CFR data, healthcare professionals and communities can significantly enhance their efforts in improving conversations with families, implementing effective quality improvement projects within healthcare settings, and advocating for impactful policies and initiatives aimed at preventing SUID and ensuring infant safe sleep. The webinar underscored the shared responsibility in creating a safer sleep environment for all infants and highlighted the upcoming conference as a valuable opportunity for continued learning and collaboration.

This executive summary was generated using an AI-powered tool to enhance clarity, efficiency, and readability. While AI assisted in drafting this summary, it has been reviewed and refined to ensure accuracy and alignment with our objectives.