Reducing Pregnancy Complications Through Staffing and Technology
By Matt Phillion
According to the U.S. Centers for Disease Control and Prevention, the infant death rate in the U.S. rose by 3% in 2022, climbing to 5.6 deaths per 1,000 live births. This marks the first significant increase in about 20 years. How is evidence-based perinatal research able to affect new care practices to address pregnancy-related complications and what can the industry do to improve clinical decisions and early interventions?
“I think this is a huge question. For clinicians in this setting, we read stats like this and it lights a fire: what solutions can we bring into the setting to help address these issues?” says Whitney Weighall, BSN, RN, director clinical implementations for CliniComp. “I’ve been in the trenches and so I’m thinking of the tools we have at our disposal, the technology we have to empower the clinicians at the bedside.”
The COVID-19 pandemic continues to cast a long shadow, as burnout and staffing shortages clearly have an impact across all areas of healthcare.
“Burnout is huge. Nurses in obstetrics were already facing burnout. It’s a wonderful field but there are highs and lows, so it can be a stressful area to work. And then add in COVID and the restrictions that came with it—limited numbers of visitors, relying more on nurses and support staff when doula’s access was limited—that extra burden falls on the nurses and other members of the care team,” Weighall says. “And that’s above and beyond what the nurses were experiencing during COVID.”
“I agree with the general sentiment about burnout, but many of the issues existed before that. It kind of exposed the issues,” says M. Bardett Fausett, MD, MFM, maternal fetal medicine specialist and president and medical director of Origin Health LLC. “People are working long hours, and in healthcare we don’t have the luxury other industries do where you can take a mandatory rest. I’ve had four hours sleep in the past two and a half days. There just aren’t a lot of people to provide coverage, and we’re stretched thin. It really is a challenge.”
Fausett highlights the emotional burden Weighall mentioned and its impact on retention of veteran practitioners.
“We see the very best of things in the perinatal world. I also see some of the most complicated pregnancies. The joys of helping someone get through something very difficult also means sometimes you deal with the losses,” he says. “One dear friend was reaching retirement age but still capable of doing great work, but he finally stopped and said it was because he couldn’t take one more loss.”
Fausett notes that it’s not just an overburdened staff that’s at the heart of the issues. All across the country, we can find maternity and perinatal care deserts where there’s no one in a reasonable distance to turn to when mothers and babies need care.
“I live in Montana where we have a lot of counties where they just don’t have access to labor and delivery services. If an area has a very small population, to maintain an active and available labor and delivery unit with adequate supplies and staff can be incredibly difficult,” says Fausett.
Fausett also notes that there’s a change in the overall health of patients, too, which must be addressed.
“Most pregnancies are complicated, and that adds to the morbidity rates, especially if those women are getting care in less medically oriented situations” such as home births, he says.
There’s a need to find a way to make the experience normal, happy, and pleasant, he says.
Identifying areas of improvement
What can the industry do to right the ship and see these numbers go down again? It begins with the right tools, says Weighall.
“When nurses are intaking their patients, they’re taking the prenatal history, labs, vitals, and all of this is within the EHR,” she says. “It’s a matter of using that data to be able to provide alerts to the clinicians. OB care is a multidisciplinary area, and nurses and doctors need to be able to make sure data is not sequestered.”
What information is readily available at a glance?
“When the provider needs to take a quick look at the patient, whether that’s the fetal strip or the patient’s record or a dashboard, we need to make sure those are consistent throughout the system and visible to all team members,” says Weighall. “Communication among the team members is really important and EHR technology can support that in a critical way making sure pertinent patient data is visible throughout the system in key locations.”
Fausett mentions a recent case in which an expectant mother had pregestational diabetes, which leads to a complicated pregnancy—but this condition wasn’t indicated in the initial referral or consultation.
“It’s partly about medical integration. One of the things we’ve done in our company is work hard to get medical records into the hands of the patients,” says Fausett. “When I was active duty military, we worked on a project that created perinatal records women could bring with them when they show up to a new provider. So if something happens—she’s rushed to the ED in the middle of the night, she’s in an accident—there’s a ‘pregnancy passport’ providing invaluable information.”
This helped us remove the challenge of inconsistencies between outpatient, inpatient, or written records and integrate all information into one source of truth.
“We learned that from Europe: German physicians would give women a ‘Mutterpass,’ or Mother’s Passport,” says Fausett. This document would contain all pertinent information such as test results and exams during the pregnancy.
It’s necessary to leverage new and emerging technologies in a positive way to offset confusion and burnout, Fausett says.
“One of the challenges with burnout is the number of systems we have,” he says. “One of the primary problems we face as providers is documentation. We need medical record systems that are integrated, comprehensive, and have alerts that make our lives easier and make it easier to document so you’re not spending three quarters of your time in front of a computer instead of a patient.”
Using newer technology to assist with documentation should enable a huge step forward in quality of care, he says.
“You wouldn’t believe how much time we spend documenting. Sometimes it’s not even helpful from a care perspective. Sometimes it’s just legal documentation,” says Fausett. “However, leveraging technology to optimize our time with the patient will contribute to great outcomes.”
The importance of patient engagement can’t be overlooked, Fausett notes. With providers needing to see 50 or 60 patients per day to stay ahead, anything that can help alleviate burnout and provide more time with direct interaction with the patient is important. It also helps retain skilled, veteran staff.
The right technology to move forward
The best way to keep the quality staff who are in the profession is to provide them with technology that makes their job easier and decreases burnout, says Weighall.
“A lot of us went into this profession because of the patients. Laboring with a patient is one of my favorite things about the job, so the ability to monitor multiple patients and to have good communication with the care team goes a long way,” she says.
Fausett points to the medical record as an area that will improve outcomes.
“Make it easy to use, AI-driven or supported so you don’t have to repeat the same information but rather bring critical information forward from record system to record system or inpatient to outpatient so that data is seamlessly available and accurate and there aren’t multiple forms of it,” he says. “It’s less about billing or admin or medical legal purposes and really about documenting the key things in that visit.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.