Joint Commission Targets Maternal Health Crisis

By Christopher Cheney

The Joint Commission (TJC) has released two advisories aimed at addressing maternal mortality and morbidity.

In several reports, the United States has the highest maternal mortality rate compared to other developed countries—a report from The Commonwealth Fund found the United States had the worst maternal mortality rate compared to 10 other developed countries. According to a Centers for Disease Control and Prevention (CDC) report, the U.S. maternal mortality rate rose from 20.1 deaths per 100,000 live births in 2019 to 23.8 in 2020. The CDC report highlighted a racial disparity, with the maternal mortality rate for Black women at 55.3 deaths per 100,000 live births, which was nearly three times higher than the rate for White women.

This week, TJC released a Sentinel Event Alert and Quick Safety advisory on maternal mortality and morbidity. “We must address the maternal health crisis immediately, especially as the COVID-19 pandemic exacerbated racial disparities in pregnancy-related outcomes,” Ana Pujols McKee, MD, executive vice president, chief medical officer, and chief diversity, equity and inclusion officer of TJC, said in a prepared statement.

Sentinel Event Alert: Eliminating disparities for pregnant patients

The Sentinel Event Alert focuses on disparities and how social determinants of health (SDOH) affect pregnancy-related mortality and morbidity. The SDOH impacting pregnancy include housing, food insecurity, lack of access to healthcare, insurance, transportation, low income, and racism. “The stress associated with living with these conditions contributes to pregnancy-related mortality and morbidity,” the Sentinel Event Alert says.

The Sentinel Event Alert suggests six actions that healthcare providers can take:

1. Promote prenatal care access. Boosting access to prenatal care is especially important in rural communities and communities that have provider shortages and health disparities.

2. Screening patients during prenatal care. Providers should screen pregnant women for hypertension, hemorrhage risk, and socioeconomic risk factors. One key resource is TJC’s Health-Related Social Needs Screening Question Bank.

3. Provide support and options that address the expectations of patients. Options should include home birth and birthing centers, while managing pregnancy complication risks. Pregnant women and their clinicians should share decision-making. Provide education and training for the interdisciplinary care team to reduce low-risk C-sections and promote vaginal birth.

4. Prepare for hemorrhage and other medical complications. Hemorrhage is a leading cause of maternal mortality and morbidity. Quick action is essential because every second of delay increases blood loss and the risk of death.

5. Implement performance standards and improvement initiatives. For example, there should be regular huddles and post-event debriefings to assess outcomes and identify opportunities for process improvement.

6. Provide universal training to address unconscious biases of healthcare providers toward people of color. Providers should educate staff about healthcare disparities and health equity issues related to pregnancy. Providers should promote inclusiveness, interdependence, acknowledgment, and respect for racial and ethnic differences.

Quick Safety: Mental health conditions leading cause of maternal mortality

A CDC report found that mental health conditions are the top cause of pregnancy-related deaths. The report found that mental health conditions were the underlying cause of death in 22.7% of maternal mortality cases. Hemorrhage was the second-leading underlying cause of death at 13.7% of maternal mortality cases.

The Quick Safety advisory released this week features seven safety actions providers can take to address mental health conditions related to pregnancy:

1. Conduct perinatal screening for depression and anxiety using a validated tool. Conduct an assessment of mood and emotional well-being during the postpartum visit. Additional screening of new mothers should be conducted during the well child visit.

2. Closely monitor pregnant patients for mental health conditions. Providers should evaluate and assess pregnant patients who have depression or anxiety, a history of perinatal mood disorders, risk factors for perinatal mood disorders, or suicidal ideation.

3. Be prepared to start medical therapy or refer patients to behavioral health resources.

4. Have processes to ensure follow-up for further assessment, screening, diagnosis, and treatment.

5. During the interpregnancy period, screen for depression and substance use disorder as part of well woman exams and offer referrals and resources if appropriate.

6. Create a clinical workflow to identify suicidal ideation and behaviors. Elements of the workflow should include reducing access to lethal means, collaborative safety plans, and caring contacts such as hand-offs to skilled providers.

7. Train staff in the clinical workflow to identify suicidal ideation and behaviors.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.