Closing the Gaps in Perinatal Care
Children’s Memorial Hermann Hospital, McGovern Medical School at The University of Texas Health Science Center at Houston and the March of Dimes announced Tuesday the establishment of the first research center in the country dedicated to improving maternal and infant safety and preventing unnecessary illness and death.
Officially titled the March of Dimes Perinatal Safety Center, the project is designed to identify sources of patient harm and develop evidence-based techniques and training tools that can minimize human error and close the gaps in care between pregnancy, labor, delivery, postnatal care and the transition home. The institutions will use the information gathered to develop a blueprint for best practices that other hospitals around the country can implement.
The center is funded by a three-year, $2-million grant from The Gordon and Betty Moore Foundation and the Joe Kiani/Masimo Corporation to the March of Dimes.
“We certainly know that a lot of hospitals, like Children’s Memorial Hermann and many other hospitals, do a fantastic job of taking care of patients and babies when they’re here, supporting the families that are here,” March of Dimes President Stacey D. Stewart said. “But like a lot of other industries, everyone’s always interested in how you can do better, how you can improve the outcomes and how you can make sure that every baby is as safe as possible. There’s no room for error.”
While it’s important for hospitals to be highly reliable, “it’s easier said than done,” said the center’s principal investigator KuoJen Tsao, M.D., the Children’s Fund, Inc., Distinguished Professor in Pediatric Surgery at McGovern Medical School and co-director of The Fetal Center at Children’s Memorial Hermann Hospital.
“Our ultimate goal is to really improve the culture of patient safety,” Tsao said. “We think we are a safe organization. We think we do everything safely. But can we measure it so we identify the hot spots and how to make it better?”
Children’s Memorial Hermann annually delivers more than 5,200 babies, performs 5,800 pediatric surgeries and offers more than 40 maternal and pediatric specialties, including high-risk pregnancy, NICU and neonatal care, pediatric trauma and neuroscience. It also has one of only four Level IV NICUs in the state to care for the most critically ill babies.
Throughout pregnancy, labor and delivery, patients typically transition from outpatient care with their primary OB-GYN doctors to inpatient care with a team of delivery specialists at the hospital. Once the baby is born, they are then handed off to a team of neonatal specialists. The teams working in silos can lead to blind spots and barriers within the health care system and create medical errors anywhere along the process.
“We know that once you hit the hospital, you are taken care of … by people, and people make mistakes,” Tsao said. “We usually have systems for obstetricians or systems for the NICU, but it’s really about creating one entire system [for] two patients from the beginning when they’re born, to after they’re born, to when they go home.”
The journey through the hospital system can be even more complicated for premature babies who require extra care. On average, a premature baby will stay in the NICU for four months, according to Amir Khan, M.D., medical director of Children’s Memorial Hermann Hospital NICU and administrative director of neonatology at McGovern Medical School.
“You have to do everything right every day for 120 days, which basically means you have to make sure that the … 20 to 30 nurses, about five to six doctors and a whole bunch of other people are trained enough to take care of that specific baby for that period of time,” Khan said. “Sustaining it is the hardest part. One mistake can result in a very, very bad outcome.”
The initiative will focus on four clinic areas:
- Increasing the use of antenatal corticosteroids (ACS) for women at risk of preterm birth to help improve the baby’s lung function: Administering a single course of corticosteroids to women who were at risk of premature birth has been shown to reduce the baby’s risk of death by approximately 30 percent. Children’s Memorial Hermann will continue to administer the corticosteroids to at-risk women between 24 and 34 weeks of gestation.
- Increasing maternal immunizations for flu and whooping cough to protect newborns: Vaccines for the flu and whooping cough are safe for women during pregnancy. Because pregnancy can change a woman’s immune system, heart and lung functions, contracting the flu can cause women to become seriously ill and puts the baby at risk for developmental problems and premature birth. The U.S. Centers for Disease Control and Prevention reported that up to 20 babies die each year in the country from whooping cough and approximately half of babies under 1 year old will need to be treated in the hospital for the disease. Getting vaccinated for whooping cough and flu during pregnancy allows the body to create antibodies that can protect the baby before birth.
- Improving the mother and baby’s transition from hospital to home: According to the American Academy of Pediatrics, babies who were born preterm with low birth weight and treated in the NICU had a higher rate of hospital readmission and death during their first year of life. The Perinatal Safety Center plans to develop an app that will help parents take care of their babies after they leave the hospital.
- Reducing the number of medically unnecessary deliveries before 39 weeks of gestation: According to the March of Dimes, early elective deliveries after 37 weeks and before the full 39 weeks of gestation can put the baby at risk for NICU admissions, transient tachypnea, respiratory distress, ventilator support, sepsis and difficulties feeding.
By the end of the three years, Tsao hopes the center will be able to develop a Perinatal Safety Center toolkit with recommendations and best practices for all four clinical areas that other hospitals can implement in the future.