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Boosting Access to High-Quality, Equitable Child and Maternal Care

May 25, 2023
May 25, 2023

In a recent ASHRM Podcast, from the American Society for Healthcare Risk Management, the importance of equitable access to child and maternal care was discussed, as well as ways to reduce both pre-natal and post-natal risks to mothers and infants. The discussion included the following guests:

 

  • Henry Lerner, obstetrician-gynecologist, Emeritus Assistant Clinical Professor at Harvard Medical School, and founder of Newton-Wellesly OB/GYN. He has delivered over 10,000 babies and has performed over 6,000 gynecologic surgical procedures. Dr. Lerner has also spent much of his career working the areas of obstetrical patient safety and medical malpractice
  • Patricia Scott, the coordinator of the advanced practitioner group for Mednax Medical Group as well as coordinator of the neonatal transport service at Centennial Medical Center in Nashville, Tennessee. She is involved in quality improvement at the state level through her work with the Tennessee Initiative for Perinatal Quality Care. She is also an assistant professor in the neonatal nurse practitioner program at Vanderbilt University School of Nursing and an active NRP and S.T.A.B.L.E. instructor.
  • Linda Zimmer, MSN, RN, has clinical experience in the areas of critical care, pediatrics, and medical-surgical care. She is a Senior Program Manager on HealthStream’s Clinical Programs team where she leads delivery of Child and Maternal Health solutions. Ms. Zimmer was previously System Director of Patient Experience at Cox Health, focused on improving performance in HCAHPS and NPS measures, reducing variation in clinical practice, and collaborating with various leaders to build skills and attain goals of a high-performing organization.

 

Ms. Zimmer outlined the risks, with the U.S. having the highest maternal mortality rate among wealthy nations of the world. This is a complex issue doctors and nurses throughout the U.S. urgently hope to address, something HealthStream has seen firsthand amongst their own customers and partners. Ms. Zimmer recalled the “layering process” of new and existing initiatives that she dealt with in her own experience as a nursing director, complicating the progress toward improvement. She stated that other disruptors, such as financial constraints or nursing shortages, were definitely affecting customers, and reiterated HealthStream hoped to utilize their unique position as a leading provider of learning applications to have meaningful conversations with partners across the country to determine the best course of action.

Dr. Lerner agreed with the importance of providing education to physicians and nurses, a vitally important component. He explained that the maternal death statistics include a large percentage of women whose death is due to trauma, violence, accident, or suicide, rather than something that happened during the course of care, a distinction that is difficult but important make. He further reiterated that while it’s also true the most serious emergencies rarely happen (such as amniotic fluid embolus, shoulder dystocia, or cord prolapse), the downside is that practitioners who have very little experience with these problems may not have the training to handle them when they do occur. For this reason, it is important that they have practice in dealing with emergencies. The safest way for this to happen is through training, usually in the form of simulation.

HealthStream offers such simulation, in the form of short 15- to 30-minute practice intervals that cover major obstetrical emergencies, allowing practitioners to train for these problems using real-life scenarios. As an example of potential obstacle that might be found in the course of this training, Dr. Lerner observed that a practice drill could determine that a crash cart was too far away from patients and thus would not be ready in time when an emergency occurred. Dr. Lerner noted he has worked with HealthStream to develop a series of courses to cover obstetrical emergencies that include both didactic and simulation components.

Dr. Lerner also mentioned the problem of 24-hour, in-house coverage, particularly at smaller community hospitals with staffing issues. Obstetric emergencies occur and must be dealt with in minutes, making this a very serious situation. He noted institutions are implementing laborist programs or an obstetrical hospitalist, which can solve these issues and also save the facility money over time. Other useful programs include residency and fellowship, as well as the use of checklists for reference, which can be extremely helpful in avoiding mistakes in care.

Dr. Scott noted the fact that rural hospitals have experienced the loss of birthing centers, putting more strain on the ones that do stay open to serve an even larger population, increasing the need for more training for those practitioners. Further, she reiterated that the same training for emergencies dealing with the mother also apply to the newborn, particularly in the birth of a preterm baby – for instance, the care and treatment for a baby born at 26 weeks is incredibly more complex than that of a full-term baby. She noted the importance of airway management – would practitioners know how to provide effective positive pressure ventilation to a newborn not breathing on its own? As with maternal care, babies born after prolapse cord or placental abruption also require special care.

In these situations, simulation training is equally important. Dr. Scott explained the NRP Neonatal Resuscitation Program, as well as S.T.A.B.L.E., covers these emergency scenarios. Airway, blood pressure, glucose levels, even emotional support for the family – all of these are vital areas of quality perinatal care that this training addresses. Further, such training helps with the standardization of care, as Dr. Scott reiterated is important regardless of whether it’s at a rural facility, community hospital, or large healthcare system.

Finally, Ms. Zimmer pointed to the importance of distinguishing between merely delivering more education as opposed to personalized training that’s designed for the learner, in addition to inter-professional skills training that focuses on the team as a whole. Through pre-assessments and screening tools, training can be focused to the skills that each individual needs help with the most.