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Health care: Less convenience, better results
By Jason Lesley
Obstetricians Christine Gerber and Lisa Maselli made a decision a few years ago to stop delivering babies early as a convenience for parents, the Georgetown Hospital System staff or even themselves.
Research said that lungs of babies delivered before 39 weeks were not fully developed.
The decision, Gerber said, was not popular.
“It was a big deal to tell people that we were not going to do your C-section until you are exactly 39 weeks pregnant,” she said. “Patients watch TV and read the Internet and think we can wave a magic wand over them and induce labor. Elective deliveries before 39 weeks are not a good idea. It was an educational process for our patients. It seemed to them like we were torturing them, making them stay pregnant for three or four more days. That last month of pregnancy is no fun.”
The doctors’ decision had repercussions. Women needing Caesarean section surgery were coming to the hospital in labor on weekends and in the middle of the night. Waccamaw Community Hospital does not keep surgery staff in the hospital overnight or on weekends, so doctors, nurses and anesthesiologists were called in when needed.
“In the end,” Gerber said, “the answer to every objection was it’s the right thing to do.”
For that change in hospital policy and others that followed, Gerber and Maselli received one of five Lewis Blackman Patient Safety Awards at the South Carolina Patient Safety Symposium in Columbia last week. The awards were created in 2008 to recognize individuals who demonstrate exemplary dedication and leadership in advancing the quality and safety of health care for patients.
Lewis Blackman was 15 when he died of preventable medical complications after elective surgery. “Multiple things did not get recognized,” Gerber said, “because people assumed Lewis Blackman was a healthy, young kid. Multiple people assumed the blood pressure cuff was broken rather than becoming alarmed that he might go into shock.”
His mother, Helen Haskell, made improving medical care her mission and founded Mothers Against Medical Error.
Within the first six months of their 39-week directive, the doctors decided to take on other issues with obstetrics.
“We were doing things differently at the two hospitals, not dramatically, but we wanted to consolidate,” Gerber said. “The same doctors go back and forth. We wanted standard medication doses, standard IV solutions and standard ways of managing our OB care. Other projects involved safety for patients.”
When speakers at a South Carolina patient safety symposium presented the idea of ending elective deliveries before 39 weeks, Gerber and Maselli said they had stopped two years ago.
“If the mom is sick or the baby is sick, we will deliver early,” Gerber said. “There are heart-breaking things like the husband being deployed that we get pressure from. One wanted an early delivery because her mother-in-law was in town to baby-sit her other children.” Some people have been disappointed, Maselli said.
Benefits of the 39-week initiative have started to emerge. There have been fewer C-sections, and the number of days of extra baby monitoring have dropped by 200 a year.
Changes in procedure have improved patient care in other areas. A stroke task force was appointed, changing the response to symptoms that may be a stroke. Patients get an immediate consultation over Skype with a neurologist at the Medical University of South Carolina. “There are time frames that we’re constantly monitoring,” Gerber said, “to get blood thinners and CAT scans done.”
Maselli calls this evidenced based medicine. “Some physicians can look at it with a different spin: people saying how I should practice. Nobody is doing that. We are trying to set a standard. You can deviate from it depending on circumstances.”
Patients have been given more of a voice in their treatment. If they believe there’s a problem, patients can call a rapid response team of highly qualified nurses and doctors to their rooms. “When the rapid response teams were first being developed,” Maselli said, “we determined that the patient has to be able to call. The nurse doesn’t realize how sick you’re getting and 12 people show up to figure out what’s going on.”
Another change in obstetrics was suggested by a patient: Stop taking the baby away from the mother for a bath and eye drops and other non-emergency procedures after a C-section. Now the surgeon puts the newborn on the mother’s chest and she goes to her room with a recovery room nurse. “She has no break in her time with the baby,” Gerber said. “I don’t know why we didn’t think of it.”
Gerber and Maselli, specialists with Carolina OB-GYN in Georgetown and Murrells Inlet, will speak about their award to the Institute for Health Care Improvement for perinatal medicine in New Orleans May 29.