Deborah Howell (Host): As so many couples know, a due
date is not always exactly on the money. Sometimes the baby has other ideas,
and sometimes the parents and babies have the need for special services. So
when the need arises for maternal and neonatal transport, it's good to know
you're covered right here, close to home.

Today we'll talk with two experts about the maternal and
neonatal transport services at Deaconess, the Women's Hospital. I'm Deborah
Howell, and our guests are Dr. Ron Pyle, a Neonatologist Physician and Director
of Neonatal Transport, Medical Director of Neonatology at the Women's Hospital.
And Dr. Brennan Fitzpatrick, Board Certified Maternal Fetal Medicine Physician
at Tri-State Perinatology and Medical Director of Maternal Transport at the
Women's Hospital. Welcome Dr. Pyle and Dr. Fitzpatrick.

Ron Pyle, DO: Thank you.

Brennan Fitzpatrick, CMO, MD, MBA, FACOG: Thank you for
having us, Deborah.

Host: Dr. Fitzpatrick, let's start with you. How would
you define maternal transport and what are the pieces that make up a transport
team?

Brennan Fitzpatrick, CMO, MD, MBA, FACOG: So maternal
transport is based on the concept that not every hospital has all of the
resources available to them to take care of high risk moms and high risk
babies. So we have 82 birthing hospitals in the state of Indiana. There are 10
perinatal centers, which by definition, have access to more resources to care
for some of the sickest mothers and babies. And so, the notion of transport is
built around getting moms and babies access to those higher level centers. And
so, as you were saying in your introduction, obstetrics is sort of predictably
unpredictable.

And so a lot of times we don't know when mom is going to go
into labor, and baby's going to arrive. And sometimes, the most important thing
is to have them seek medical care at the closest facility to them. But even
still that facility may not have the resources to fully care for both mom and
baby. And, so what our job is from a transport perspective, is to mobilize
those resources, and provide them for those patients at those outside
hospitals. So we actually have an ambulance, that is equipped with the
necessary equipment to sort of help care for those patients out in the field.

It also has the expertise of a maternal nurse, a neonatal
nurse, a respiratory therapist. So there's a whole team that gets on that
ambulance and goes out to the outlying hospital, will assess the situation when
they arrive at that hospital, and then work with one of our Maternal Fetal
Medicine specialists on how best to proceed, whether it be delivering care in
the field or bringing that patient back to the women's hospital.

But I think ultimately, the whole key to that is having access
to all of those resources and having those resources be able to be mobilized to
send out in the field and ensure that patients are being appropriately taken
care of.

Host: Sure. And what types of patients does the maternal
transport serve?

Brennan Fitzpatrick, CMO, MD, MBA, FACOG: Generally
speaking, we deal with a lot of patients that have obstetrical complications.
Things like preterm labor, pre-eclampsia, which is a high blood pressure
disease that we see just during pregnancy, those types of issues. Occasionally,
we'll have patients that have significant critical care issues. In fact, we
just took a patient recently, who has a bad heart history and was having
symptoms consistent with a heart attack and was pregnant. And so, we went and
used our team to pick up that patient and bring her back to our heart hospital
on the Gateway campus here in Evansville.

Host: Wow, I mean, really incredible. How would you
define neonatal transport and what are the pieces that make up a neonatal
transport team? And this question's for Dr. Pyle.

Ron Pyle, DO: Well, I think the best description or
definition for me is that it's taking our NICU or an extension of our NICU and
putting it in your nursery, in your hospital, to help care for that infant.
Again, and Dr. Fitzpatrick alluded to, with delivery hospitals around here and
with 10 perinatal levels centers of care, that really, the idea is to provide a
resource for these hospitals that they can reach out to. And the idea for
Neonatal Transport is not, Hey, I'm going to come take your baby.

It's to provide information, provide recommendations to try to
stabilize that kid as best as we can, before transport, and then make a
decision together, with the referring doctor about, okay, we're going to send
our team and help transport that baby back to us so that we can continue care.
So the makeup of that team is interesting. It's actually, we do a nurse-led
team, and it's a NICU nurse and a NICU respiratory therapist. And the goal is,
is that we train extensively, just as Dr. Fitzpatrick's maternal team does. And
so these are kind of special individuals and so these members make up the team,
like I said, it's nurse-led, and they are trained to handle pretty much
everything they walk into, they might see.

Host: Okay. And what types of patients does neonatal
transport serve?

Ron Pyle, DO: The majority of cases are based on
prematurity, and so the underlying source of that is immature lung disease. We
call it, surfactant deficiency or respiratory distress syndrome. And so the
majority of kids we deal with are respiratory driven, but we also deal with
seizures. We deal with stabilization of potential cardiac kids as well as we
have such great support from our administration that we have a new device. I
love it. Therapeutic hypothermia. It's one of the only modalities ever proven
to help kids who may be hypoxic at birth or lack of oxygen at birth and it's
actually called the Tecotherm, and it's a cooling device we can use on
transport that will cool these babies down to protect their brains, and it's
really neat.

Host: Wow, that's incredible. Dr. Fitzpatrick, back to
you. Why did the women's hospital start maternal and neonatal transport
programs? I mean, how did you know there was a need for these programs?

Brennan Fitzpatrick, CMO, MD, MBA, FACOG: I think, I
arrived in 2008, and we had the ability to take transports into the hospital.
But I think the concern was that you would tell the patient, a lot of times to
go to the closest hospital. And, that may be in an area where they don't have a
ton of resources. And then ultimately that hospital would transport the patient
to us. And so you went from this higher level of care. And then none of the
specific services related to obstetrics and maternal transport were offered on
the rig. So then you would drop down to this lower level of care and then the
patient would arrive, hopefully safely, at the Women's Hospital where they
would receive the higher level of care again.

And it didn't make a ton of sense to me to have that period of
time where the resources weren't available to take care of the patient if there
was an emergency on the ambulance. And that was a real worry. So you'd be biting
your nails, sometimes, patients would be on that ambulance for an hour or an
hour and a half, as they're coming to your hospital and you're just hoping
everything goes okay.

And so we didn't feel like that was the safest way to do
things. So we, in 2014, put together our, our formal transport team. And,
basically, worked with these individuals who were all really high performing
nurses and respiratory therapists, sort of an elite group and put them together
and, trained them, to be able to not only assess in the field, but also to
deliver care in the field, to safely bring those patients, back to our
hospital. So, you know, I think at the end of the day, it really was about,
ensuring that these patients were getting from one hospital to another hospital,
in the safest possible manner.

Ron Pyle, DO: I think, the underlying thing that Dr.
Fitzpatrick and kind of extrapolated into myself was that the transport
program, everything we do here is evidence-based medicine and we always try to
be on the cutting edge of treatment and care. And so, I know from my
perspective, Dr. Fitzpatrick, and correct me if I'm wrong, Dr. Fitzpatrick, but
what came out of this was also education and teaching. And so the goal is, is
that the transport program actually became a teaching vehicle as well. And so
we tried to extend those resources of education, policies, procedures, so that
in reality, these referring hospitals, these patients will be better treated,
better stabilized, and so forth. But it is kind of an extension and it extended
into education and, and teaching as well.

Host: Sure. Very necessary component. For both of you,
what are some of the challenges you've experienced in creating the Women's
Hospital's transport programs? And we'll start with you, Dr. Pyle.

Ron Pyle, DO: I think in starting any program, it's
about understanding what your resources are at your facility. And once you have
those, you know, you can ask individuals to join the team, you can train them,
but it's also about developing policies, following the AAP, the American
Academy of Pediatrics, the state's IP quick guidelines, making sure you're in
aligned with all those programs.

But, I think, making sure you have policies to cover, make sure
that you have prepared your team. And in doing that, in developing that
program, as again, Dr. Fitzpatrick said, is that these are unique individuals.
They're highly driven. They are top performers that you get in the NICU or the
maternal side and then taking them and saying, I'm going to put you in
situations that may make you uncomfortable.

And that's a term that Dr. Fitzpatrick can explain about
uncomfortable. I think he does it very well. But, the idea is that we're going
to walk into situations, but I'm going t take these individuals and train them
to think in the mindset of transport. Because in the field you have resources,
but it's really about critical thinking.

Host: Okay. And Dr. Fitzpatrick.

Brennan Fitzpatrick, CMO, MD, MBA, FACOG: I think that
we have empowered our team to make decisions. And in some cases when they
arrive on site, culturally, there can be differences in how physicians interact
with our team. And, I think sometimes that challenging, making sure that the
members of our team are taking on a, I mean, it's a big deal and to Dr. Pyle's
point, they are going to be in positions, at times, where it's not easy or it's
uncomfortable. And I think the one thing that we talk about with them is, I do
high risk obstetrics, so I'm chronically uncomfortable.

But the question that you have to ask is, do we have the
resources to care for this specific patient? And I think doing the calculus to
assess the resources that an outside hospital would have, the resources that we
have, I think that that's a key component of what we do. And, I think that
helps them to understand that even though situations may be challenging, and
they may be dealing with patients who could be very sick, that they have the
support and the resources necessary to effectively take care of those patients.

So, that piece of it. It can be daunting and I think, you know,
as we're kind of moving forward with the program, we're recruiting people to
come and join that program. And when the first thing you say in your
recruitment pitch is, it's challenging and it's hard, I think, that's always a
struggle so I think from our perspective, embracing that, and having them
embrace that and having them understand the immense amount of reward that comes
along with that is super important. And I think that that's sort of how we
address that challenge.

Host: Got it. I imagine it weeds out the candidates very
quickly. And Dr. Pyle, how do you feel that the Women's Hospital Transport
services have positively impacted our community and our region?

Ron Pyle, DO: Well, I think the key word here, Deborah,
is community And it's about keeping babies home and the resources we have, we
are capable of doing that is easy. Say we get a transfer from Jasper or even
from Vincennes, they're still close to home. That impact is huge. Otherwise
it's travel. If they have other kids, it makes it very difficult and in
reality, the other thing too is that along with the education is that one of
the things I think there's always been a false description or maybe true in
some aspects of transport is that you call us and our first response is, we're
coming and we're taking the baby. And in reality, the goal is, is that let's
stabilize the kid, see what happens, and try to team play this. And again, if
you can make decisions that can keep the baby in their community, that's great
because transport services extends far beyond just an ambulance and, and, a
team. It's about med control and that education. But in general, I think the
keyword you said was community, and it's about building that trust and knowing
that their baby's will stay home.

Host: Sure. This is for both of you. Our final question,
where do you see maternal and neonatal transport services heading in the
future? And we'll start with you, Dr. Fitzpatrick.

Brennan Fitzpatrick, CMO, MD, MBA, FACOG: I think
ultimately we want to continue to do what we're doing now, which is providing a
high level, high quality, service that improves overall care for our mothers
and babies in the region. And so, as far as what we do, with respect to these
outside hospitals, and Dr. Pyle mentioned it earlier, the education piece,
continuing to do simulation work with our outside hospitals to get them
comfortable dealing with these moms who may have specific medical issues that make
their pregnancy more difficult. And, those numbers are increasing.

People are delaying childbearing. People that have underlying
medical issues like diabetes and, high blood pressure, are getting, pregnant at
a greater clip, than maybe they were 10 or 15 years ago. So the acuity of the
patients that we see is increasing and the real challenge moving forward is not
only to be able to have the team at our hospital be comfortable with taking
care of those patients, but doing the work. That patients are safe, when they
present to an outside hospital with a specific issue. So, I think, that's we
need to be looking at moving forward, continuing to integrate with our
affiliate hospitals, and work to make sure, that every patient in our region
gets top-notch care, no matter where they initially present.

Host: Okay, and I'd just like to give both of you the
opportunity to add anything to our conversation. We'll start with you, Dr.
Pyle.

Ron Pyle, DO: The teams here provide a wonderful service
for our community. I think that they are great educators, they're great
teachers. I'm surrounded by phenomenal team members, phenomenal
administrations, phenomenal support. And with that being said, it allows us to
continually, to improve continually to look upon ourselves to say how can we
get better? And I hope that we continually to make an impact on our community.

Host: Dr. Fitzpatrick.

Brennan Fitzpatrick, CMO, MD, MBA, FACOG: I think that
we have been very fortunate to have an administration that has supported this
endeavor from the get-go, pouring resources and effort and time into developing
something that I think is on par with anything else that's offered in the
state.

I think that we have taken a leadership role on the transport
front, and we'll continue to do that. And, like I said, it's been a labor of
love. I know for myself, and I feel Dr. Pyle would say the same. And we've been
very, very fortunate to develop something that our community can be really
proud of.

Host: And perhaps a model for other hospitals along the
way, maybe.

Brennan Fitzpatrick, CMO, MD, MBA, FACOG: Certainly.

Host: Well, thank you so much, Dr. Pyle and Dr.
Fitzpatrick for your time and your expertise today. We really, really enjoyed
having you on the show.

Brennan Fitzpatrick, CMO, MD, MBA, FACOG: Thank you so
much.

Ron Pyle, DO: Thank you, Deborah.

Host: And to learn more about the Women's Hospital,
please visit www.deaconess.com/theWomen'sHospital. That's all for this time.
I'm Deborah Howell. Have yourself a terrific day.