Maternal Mortality, Nursing Shortages, and more – Supporting the OB Service Line with Perinatal Telemonitoring
By Dr. Alana McGolrick, PeriGen
If you live anywhere in the United States, now is an unfamiliar time to be an expectant mother. Everyone in healthcare should be acutely concerned about the horrendous statistics regarding maternal morbidity and mortality in the US. Recent headlines such as USA Today’s recent “Hospitals Failing New Moms” are shining a light on what to date has been a slow-burning public health crisis.
A report in Obstetrics & Gynecology shows that in the U.S., the number of maternal deaths in this century increased from nearly 19 in 100,000 live births in 2000 to almost 24 in 2014.[i] This translates to roughly 700 to 900 maternal deaths each year, of which at least half are considered preventable.2 Labor and delivery presents a difficult conundrum to many hospital administrators. It is a critical service line to maintain as a public service, a census builder, and the gateway to life-long patients. However, administrations are hamstrung by maintaining safe patient care, and managing high-risk patients while dealing with a nursing shortage.
Critical Service Line
With the high maternal morbidity rate (MMR) which affects all mothers in the U.S, there is an additional disadvantage for mothers in the 54% of rural counties that lack hospital OB units and areas where 120 rural hospitals have shut down completely over the last decade. These factors create more pressure on the remaining hospitals while increasing inconvenience and risk for mothers and babies.
For those hospitals, implementing advanced technology that monitors mothers and babies throughout the stages of childbirth could provide support for OB nurses and physicians who are already stretched thin. The costs, however, may be beyond the budgets of small rural or critical access hospitals.
Even with technology, their OB staff may be smaller than that of their more urban counterparts. And while their clinicians may be excellent, they may have less experience managing difficult labors and deliveries (L&D). As a result, rural hospital executives may elect to close their OB units rather than chance the clinical and financial risks in an increasingly litigious society.
Managing High-risk Patients
Under normal circumstances preparing for labor and delivery can be difficult in even the most sophisticated, well-equipped OB departments. The logistics of preparing for and maintaining a healthy pregnancy and delivery has become even more challenging when pandemic precautions are factored in. Still, the American Academy of Pediatrics (AAP) continues to emphasize that the safest place to have a baby is a hospital or accredited birthing center.
There are many contributing factors to the rising morbidity and mortality rate including multiple co-morbidities associated with pregnancy. Obesity, hypertension, and diabetes represent specific risk factors that need to be closely managed during pregnancy and childbirth. Social, economic, and cultural factors may also play a role in maternal morbidity and mortality, unfortunately we are unable to confirm actual numbers as there is a great possibility that these numbers are severely under-reported due to lack of accurate collection. If this is the case, then we can be assured that our patients continue to be at high risk for experiencing unexpected outcomes during labor and delivery.
The US has some of the best trained nurses in the world, rarely is a bad outcome in childbirth related to a poorly trained nurse. Unfortunately, we have experienced a high level of attrition which is multifactorial. The literature has shown that causative factors include the crushing impact of the pandemic, lack of staffing ratios, and perceived unsafe staffing conditions. These conditions have led to staffing vacancies to grow, leading to vulnerabilities in care for obstetric patients. Without experienced staff present to safely manage the patient load, especially when manual interpretation of data is required, and the omnipresent issue of alarm fatigue from a variety of devices just adds to the background noise. Therefore, the vast majority of bad outcomes in childbirth relate to a failure to recognize clinical warning signs making it imperative that now, more than ever before, it is urgent to consider how innovation can help stem this trend.
Sharing Expertise Through Perinatal Telemonitoring
Given the unpredictability of L&D, the goal should be to ensure that quality care during childbirth is available.
One solution that has shown early success is perinatal telemonitoring. This arrangement gives experienced OB nurses in larger urban hospitals the ability to use a central command center to monitor labor progress for mothers and babies across multiple facilities using sophisticated, artificial intelligence (AI)-driven technologies that compare current readings to known outcomes.
Urban hospitals can then enter into agreements with rural and critical access hospitals to remotely monitor and review maternal vital sign, electronic fetal heart rate pattern and uterine activity. As a result, the smaller hospitals can relieve some of the workload from their nurses while instantly gaining access to the experience of the nurses and physicians in the large hospital.
Another significant benefit is the technology’s ability to spot negative trends as they develop. In some cases, these may just be subtle anomalies that a human might first dismiss.
When potential issues are discovered, the patients are highlighted on a color-coded dashboard. This signals the assigned registered nurses at the large hospital to investigate the reasons the patient has surfaced. The plan of care for the patient has been developed from an action plan that is agreed to by both the monitoring and monitored hospitals. Depending on the nature of the issue they can either recommend an intervention or consult with a physician and share it with nurses or physicians at the monitored hospital. By gaining this early warning, clinicians can intervene before small issues become more serious.
The main benefit for hospitals with perinatal telemonitoring is the extra layer of patient safety. The monitoring location is staffed with qualified personnel, objective technology, and a color-coded list of all sites sorted by severity. No matter what is happening on the unit at the time, the monitoring location is there for extra support.
One of the most significant benefits for hospitals is that contracting for these services with additional hospitals helps them defray some of the costs of the core solution. It can also positively impact the staffing costs for the remote monitoring and provides an extra layer of patient safety.
Hospitals can use the perinatal telemonitoring solution to help build its obstetric service line reputation as well. Being recognized as a community leader in obstetric care will help attract highly accomplished physicians and registered nurses in high-volume markets. It can also make the hospital the preferred choice for prospective mothers over a competitor that lacks that distinction.
A monitoring hospital may also see an increase in revenue and patient volume due to patient referrals and transfers. In fact, a rural hospital will be more prone to transfer its high-risk L&D and neonatal patients to the large hospital with which it partners.
Perinatal telemonitoring can also help hospitals solve staffing issues, such as fully covering the night shift and gaining access to more experienced clinicians, while remaining within budgetary limits. The lack of experienced staff can lead to assessment errors that turn into life-threatening events. With the backup of remote perinatal telemonitoring, nurses have the ability to consult with knowledgeable colleagues about patient care during their shifts.
Of course, the ultimate beneficiary is the mother-fetal dyad. Sophisticated, AI-driven technology that notifies the clinical team to negative trends early gives the team time to act (if necessary) before the situation worsens, helping to improve patient safety and outcomes.
During situations such as the current pandemic, reducing the number of people who must physically enter rooms to check on tracings also helps protect the mother, baby, and hospital staff against the spread of infectious disease.
Every American deserves access to quality care. Perinatal telemonitoring technology gives hospitals access to cutting-edge, AI-driven technology and expertise, enabling them to reduce clinical and financial risks while improving health outcomes. As an industry, this can’t wait. L&D needs the attention and resources NOW to make a meaningful impact and provide the public with the services they deserve. The tools and technology are here. All we need is the will.
1 MacDorman, Marian F. et al. “Is the United States Maternal Mortality Rate Increasing? Disentangling Trends from Measurement Issues Short Title: U.S. Maternal Mortality Trends.” Obstetrics and gynecology 128.3 (2016): 447–455.
2 Hoyert DL. Maternal mortality rates in the United States, 2020. NCHS Health E-Stats. 2022. DOI: https://dx.doi.org/10.15620/cdc:113967external icon.
PeriGen is a leading provider of artificial intelligence based early warning systems. For over 20 years, they have provided innovative perinatal software solutions to help clinicians protect moms and babies during childbirth.