Selected Podcast
What Does it Mean to be a Perinatal Center
Christina Ryan and Lori Grimm discuss what it means to be a Perinatal Center.
Featuring:
Christina Ryan, RN, MHA, Hon D. Science is the CEO and Chief Nursing Officer of the Deaconess Women’s Hospital.
Lori Grimm, RN | Christina Ryan, RN, MHA
Lori Grimm, RN is the Director of Perinatal Services at The Women's Hospital.Christina Ryan, RN, MHA, Hon D. Science is the CEO and Chief Nursing Officer of the Deaconess Women’s Hospital.
Transcription:
Deborah: Back in the day, a woman would go to her primary doctor while she was pregnant and then have her baby in the hospital. Well, things are a little different these days. Now, there are special places called perinatal centers. And today, we're going to dive into what they're all about.
I'm Deborah Howell and our guests today are Christina Ryan, registered nurse and CEO at The Women's Hospital, and Lori Grimm, registered nurse and Director of Perinatal Services at The Women's Hospital. Welcome to you both.
Lori Grim: Thank you.
Christina Ryan: Thank you.
Deborah: So good to have you. Chris, first to you, what are the goals of the Indiana State Rules Perinatal Levels of Care?
Christina Ryan: Sure. To put it simply, the goal for the state of Indiana was to ensure that women would deliver at the right time at the right place to reduce both maternal and infant morbidity and mortality. Back in 2012, the state of Indiana, the Department of Health and the Governor's Office established committee called IPQIK or Indiana Perinatal Quality Improvement Collaborative. I know that's a lot to say, but the goal in mind, as a number one priority, was to be able to reduce infant mortality as well as infant mortality in the state of Indiana, because our report card wasn't that great.
In 2010, as an example, right before we started this project, Indiana was 45th in the states for infant mortality as compared to the United States and 47th in the country for maternal mortality in 2018. So those were really the driving forces for the creation of perinatal levels of care or establishing perinatal Centers of excellence.
Deborah: It sounded like we had a lot of room to improve back then. So what is required to be a perinatal center now?
Lori Grim: One of the things that, is required to be a perinatal center in the state of Indiana is, first, you must be surveyed and be certified as a level III OB and level III NICU facility, which means that you are able to care for extreme premature infants as well as very ill mothers with complications such as preeclampsia and diabetes. So that's the first hurdle in order to do so.
The next thing that's required is that we must have maternal-fetal medicine specialists available onsite and available for consultation and management for women with high-risk pregnancies. And we also must have a Director of Obstetrical Services such as an MFM or maternal-fetal medicine who has expertise in critical care in order to be available and over the service line.
The third thing that they also require is that you have an advanced practice provider available at all times to assist with education and support for the units caring for these high-risk moms and high-risk babies.
Deborah: And what do perinatal centers offer affiliates?
Lori Grim: Well, in the state of Indiana, when you're a perinatal center, what we assist our affiliates with is any hospital or any delivering facility in the state of Indiana, who is not a perinatal center, must affiliate with the center in order to provide services and help them prepare for their required survey. And they must do so in Indiana by November 2021.
Centers are responsible for providing four basic functions to their affiliates. The first of which is training. And by that, meaning we provide support and education related for NICU and obstetrical patients such as the AWHONN fetal monitoring course, the STABLE course, which is a stabilization of neonates. We also provide support for NRP, which is the equivalent of CPR, it's just for infants, as well as simulation related to high-risk events that might happen during a labor and delivery such as an emergency C-section, postpartum hemorrhage, a pre-eclamptic seizure and helping those kinds of situations that also occur in the neonates, which might be a severely depressed infant, an infant that has had an oxygen-depriving event and requires body cooling and how to stabilize those babies.
The next thing that we're required to do is to provide some quality assurance review. As part of the standards of care that we're putting place in Indiana, the state Department of Health has identified some key indicators that they really wanted hospitals to monitor and make improvements on. So as a center, we work with our affiliates to identify some of those indicators that can give them opportunities for improvement and provide support in helping them make improvement in those areas.
As a perinatal center, we also facilitate transport of those patients who are not appropriate to be in their facility. So if they have a mother who is very ill and is less than 36 weeks and needs to be transported, they can consult our MFM, maternal-fetal medicine provider, and then they can help transfer that patient to the appropriate center or hospital that can support that care. It does not mean that the affiliate does not have to send that patient to the Women's Hospital, but our physicians here will facilitate whatever hospital that mom needs to be transferred to.
And it's the same for the neonates. They can either transfer that infant to our NICU, or if it's better or more appropriate for that family, they can help facilitate the transport of that infant to another facility.
And then, a lot of other support services available. So like I said, we have to have a maternal-fetal medicine specialist here. And so they can contact that maternal-fetal medicine specialist 24/7 for a consult or a neonatologist for a newborn. And we also provide a developmental follow-up clinic for any infant that is discharged from our NICU.
Deborah: It's a lot of moving parts and it sounds like you've got to find handle on all of them. I'm curious, how do perinatal center support patients and families after discharge?
Lori Grim: So if we get a mom who has a high-risk condition or she has a newborn with a high-risk condition, what we do is we coordinate with that patient's primary care provider and our specialist here will help develop a plan of care that is established, that is appropriate for that patient upon discharge and the primary care provider services that are in his community.
There's a lot that goes into making sure that the patient has the follow-up appointments. If that patient needs follow-up with a specialist that is not in their community, our MFM or our center will help arrange those or they will be arranged with us. And from our NICU, when a baby is discharged from the follow-up clinic, we develop that same plan of care to that patient's primary provider. And there's a determination if there's services in that infant's community that can provide that. And if not, that infant can come back to the Women's Hospital and the developmental follow-up clinic, and also receive some consultation with specialists who do come to Riley at the Deaconess Hospital Campus.
Christina Ryan: To add to what Lori discussed, our ultimate goal is to co-manage these patients with their existing OB, especially if they're coming from a rural area. We have 33 counties in the state of Indiana that make up over a million in population that are in what we call an OB desert. And so some of these smaller rural hospitals depend on perinatal centers for that guidance and that support.
But ultimately, the best thing is for us to also be able to co-manage that patient. And if she can safely deliver at the level of hospital where she lives, that's what we want to do. And so that would all be incorporated too in her discharge care, if she had to stay with us as an antepartum patient for a while, until we could get her to that point where she was healthy to be able to deliver a healthy baby in her own community. That is ultimately our goal. And that is what we want to continue to strive for.
Deborah: Absolutely. And then, especially for these rural families, do perinatal centers have followup assessments?
Christina Ryan: Yes. It kind of reflects back to what Lori said. We have what we call a discharge coordinator in our NICU. And if that mom did have to deliver here at the Women's Hospital, because her care required this level, then that discharge coordinator would establish the follow-up for that baby in accordance with what the state has recommended. And that baby then, that newborn would be able to be seen in our followup clinic.
And the nice thing is it's that discharge coordinator is almost like a navigator. She is in contact with those families to make sure that they're following up appropriately, because mortality and morbidity are two different things. Mortality, obviously, we want the infants to be born alive and to be discharged home alive. But there's also morbidity, which also adds enormous amount of dollars to healthcare costs. So our goal is to make sure we're also delivering those babies and discharging them at the healthiest level that they can be.
And so that their follow-up is very important, whether it's in regards to feeding, whether it's in regards to needing to see a specialist for a while. And so all of that care then for that followup is coordinated with their primary physician back in their community.
Deborah: It sounds like nothing less than miraculous what you accomplish every day for your families. And thank you both for shedding some light on what perinatal centers have to offer. It's been great to have you both on the podcast today.
This is The Women's Hospital, a place for all your life. To learn more about The Women's Hospital Perinatal Center, head on over to deaconess.com/twh. I'm Deborah Howell. Thanks for listening and have yourself a great day
Deborah: Back in the day, a woman would go to her primary doctor while she was pregnant and then have her baby in the hospital. Well, things are a little different these days. Now, there are special places called perinatal centers. And today, we're going to dive into what they're all about.
I'm Deborah Howell and our guests today are Christina Ryan, registered nurse and CEO at The Women's Hospital, and Lori Grimm, registered nurse and Director of Perinatal Services at The Women's Hospital. Welcome to you both.
Lori Grim: Thank you.
Christina Ryan: Thank you.
Deborah: So good to have you. Chris, first to you, what are the goals of the Indiana State Rules Perinatal Levels of Care?
Christina Ryan: Sure. To put it simply, the goal for the state of Indiana was to ensure that women would deliver at the right time at the right place to reduce both maternal and infant morbidity and mortality. Back in 2012, the state of Indiana, the Department of Health and the Governor's Office established committee called IPQIK or Indiana Perinatal Quality Improvement Collaborative. I know that's a lot to say, but the goal in mind, as a number one priority, was to be able to reduce infant mortality as well as infant mortality in the state of Indiana, because our report card wasn't that great.
In 2010, as an example, right before we started this project, Indiana was 45th in the states for infant mortality as compared to the United States and 47th in the country for maternal mortality in 2018. So those were really the driving forces for the creation of perinatal levels of care or establishing perinatal Centers of excellence.
Deborah: It sounded like we had a lot of room to improve back then. So what is required to be a perinatal center now?
Lori Grim: One of the things that, is required to be a perinatal center in the state of Indiana is, first, you must be surveyed and be certified as a level III OB and level III NICU facility, which means that you are able to care for extreme premature infants as well as very ill mothers with complications such as preeclampsia and diabetes. So that's the first hurdle in order to do so.
The next thing that's required is that we must have maternal-fetal medicine specialists available onsite and available for consultation and management for women with high-risk pregnancies. And we also must have a Director of Obstetrical Services such as an MFM or maternal-fetal medicine who has expertise in critical care in order to be available and over the service line.
The third thing that they also require is that you have an advanced practice provider available at all times to assist with education and support for the units caring for these high-risk moms and high-risk babies.
Deborah: And what do perinatal centers offer affiliates?
Lori Grim: Well, in the state of Indiana, when you're a perinatal center, what we assist our affiliates with is any hospital or any delivering facility in the state of Indiana, who is not a perinatal center, must affiliate with the center in order to provide services and help them prepare for their required survey. And they must do so in Indiana by November 2021.
Centers are responsible for providing four basic functions to their affiliates. The first of which is training. And by that, meaning we provide support and education related for NICU and obstetrical patients such as the AWHONN fetal monitoring course, the STABLE course, which is a stabilization of neonates. We also provide support for NRP, which is the equivalent of CPR, it's just for infants, as well as simulation related to high-risk events that might happen during a labor and delivery such as an emergency C-section, postpartum hemorrhage, a pre-eclamptic seizure and helping those kinds of situations that also occur in the neonates, which might be a severely depressed infant, an infant that has had an oxygen-depriving event and requires body cooling and how to stabilize those babies.
The next thing that we're required to do is to provide some quality assurance review. As part of the standards of care that we're putting place in Indiana, the state Department of Health has identified some key indicators that they really wanted hospitals to monitor and make improvements on. So as a center, we work with our affiliates to identify some of those indicators that can give them opportunities for improvement and provide support in helping them make improvement in those areas.
As a perinatal center, we also facilitate transport of those patients who are not appropriate to be in their facility. So if they have a mother who is very ill and is less than 36 weeks and needs to be transported, they can consult our MFM, maternal-fetal medicine provider, and then they can help transfer that patient to the appropriate center or hospital that can support that care. It does not mean that the affiliate does not have to send that patient to the Women's Hospital, but our physicians here will facilitate whatever hospital that mom needs to be transferred to.
And it's the same for the neonates. They can either transfer that infant to our NICU, or if it's better or more appropriate for that family, they can help facilitate the transport of that infant to another facility.
And then, a lot of other support services available. So like I said, we have to have a maternal-fetal medicine specialist here. And so they can contact that maternal-fetal medicine specialist 24/7 for a consult or a neonatologist for a newborn. And we also provide a developmental follow-up clinic for any infant that is discharged from our NICU.
Deborah: It's a lot of moving parts and it sounds like you've got to find handle on all of them. I'm curious, how do perinatal center support patients and families after discharge?
Lori Grim: So if we get a mom who has a high-risk condition or she has a newborn with a high-risk condition, what we do is we coordinate with that patient's primary care provider and our specialist here will help develop a plan of care that is established, that is appropriate for that patient upon discharge and the primary care provider services that are in his community.
There's a lot that goes into making sure that the patient has the follow-up appointments. If that patient needs follow-up with a specialist that is not in their community, our MFM or our center will help arrange those or they will be arranged with us. And from our NICU, when a baby is discharged from the follow-up clinic, we develop that same plan of care to that patient's primary provider. And there's a determination if there's services in that infant's community that can provide that. And if not, that infant can come back to the Women's Hospital and the developmental follow-up clinic, and also receive some consultation with specialists who do come to Riley at the Deaconess Hospital Campus.
Christina Ryan: To add to what Lori discussed, our ultimate goal is to co-manage these patients with their existing OB, especially if they're coming from a rural area. We have 33 counties in the state of Indiana that make up over a million in population that are in what we call an OB desert. And so some of these smaller rural hospitals depend on perinatal centers for that guidance and that support.
But ultimately, the best thing is for us to also be able to co-manage that patient. And if she can safely deliver at the level of hospital where she lives, that's what we want to do. And so that would all be incorporated too in her discharge care, if she had to stay with us as an antepartum patient for a while, until we could get her to that point where she was healthy to be able to deliver a healthy baby in her own community. That is ultimately our goal. And that is what we want to continue to strive for.
Deborah: Absolutely. And then, especially for these rural families, do perinatal centers have followup assessments?
Christina Ryan: Yes. It kind of reflects back to what Lori said. We have what we call a discharge coordinator in our NICU. And if that mom did have to deliver here at the Women's Hospital, because her care required this level, then that discharge coordinator would establish the follow-up for that baby in accordance with what the state has recommended. And that baby then, that newborn would be able to be seen in our followup clinic.
And the nice thing is it's that discharge coordinator is almost like a navigator. She is in contact with those families to make sure that they're following up appropriately, because mortality and morbidity are two different things. Mortality, obviously, we want the infants to be born alive and to be discharged home alive. But there's also morbidity, which also adds enormous amount of dollars to healthcare costs. So our goal is to make sure we're also delivering those babies and discharging them at the healthiest level that they can be.
And so that their follow-up is very important, whether it's in regards to feeding, whether it's in regards to needing to see a specialist for a while. And so all of that care then for that followup is coordinated with their primary physician back in their community.
Deborah: It sounds like nothing less than miraculous what you accomplish every day for your families. And thank you both for shedding some light on what perinatal centers have to offer. It's been great to have you both on the podcast today.
This is The Women's Hospital, a place for all your life. To learn more about The Women's Hospital Perinatal Center, head on over to deaconess.com/twh. I'm Deborah Howell. Thanks for listening and have yourself a great day