It’s clear that the U.S. has a major problem in providing top-quality care for mothers.
The U.S. maternal mortality rate has more than doubled over the past 30 years, with over 700 women annually dying as a result of pregnancy-related complications. Even more disturbing, an estimated two-thirds of these deaths are preventable. A report by the Commonwealth Foundation comparing the health of U.S. women to ten other high-income countries found the U.S. outpacing its counterparts in a variety of detrimental categories, including the highest maternal mortality rates.
Minority women, in particular, are disproportionately impacted in the U.S.: black women are three times more likely to die, and American Native and Alaskan women are more than twice as likely to die than white women.
These data have galvanized policymakers, and measures are underway at both the state and federal level to identify evidence-based interventions and strategies that can help to reduce these numbers.
But there are also significant measures being taken by the medical community. With rising concerns about the growing maternal mortality rates in the U.S., many hospitals are adopting evidence-based practices and protocols to prevent more tragedies from occurring, and there are actions that hospitalists can take at the ground level to ensure that hospital partners have the best resources available when doing so.
For example, The Joint Commission currently accredits and certifies over 22,000 health care organizations throughout the U.S. The Joint Commission accreditation is not only viewed as a distinguishing symbol of approval for quality and safety standards, but is also a requirement for organizations participating in certain types of insurance reimbursement and managed care plan contract participation.
Starting in July 2020, The Joint Commission will require hospitals to meet 13 new “elements of performance” (EPs) related to maternal health as part of the accreditation requirements. This includes new standards for using prevention, early recognition, and timely treatment to address maternal hemorrhage complications and severe hypertension/preeclampsia, two of the most common causes of pregnancy-related deaths.
Hospitals will also be required, among other things, to develop written evidence-based procedures to identify and treat the conditions, stock easily accessible hemorrhage supply kits, provide role-specific education to all staff and providers who treat pregnant or postpartum patients at least every two years, conduct response procedure drills at least annually and educate patients on signs and symptoms that warrant care during hospitalization and after discharge.
OB hospitalists, while not specifically identified in the new requirements, are uniquely positioned to support hospitals’ implementation of the EPs.
For example, clinicians can actively collaborate with leadership teams at their partner hospitals to assess current efforts and confirm understanding of the Joint Commission standards, including sharing best practices about the new standards across their network of hospital partners; serving as onsite subject matter experts for hospital partners in understanding and meeting the new standards; and providing clinicians with regular, comprehensive training on maternal emergencies.
OB hospitalists can also play an important role in identifying and addressing rapidly arising situations of concern. Labor and delivery is a highly charged environment involving numerous medical professionals, each of whom may wrongly assume that someone else is noticing and addressing developing issues.
A hospitalist can minimize this potential by facilitating communication between the patient, obstetrical provider, nursing staff, and other members of the health care team.
In close coordination with the assigned provider, hospitalists can also take the lead role in educating patients at discharge on postpartum complications related to hemorrhage, hypertension, preeclampsia and other conditions identified in The Joint Commission requirements.
Their unique onsite position allows them to take as much time as needed to ensure patients fully understand warning signs and the need to return for emergency care quickly.
Reducing maternal mortality rates is a team effort and will require a commitment by both hospital leaders and providers across the full spectrum of obstetric care to make significant sustainable differences.
By working together to adopt policies proactively and ensuring that both clinical staff and hospital leadership are walking lockstep in addressing preventable deaths from occurring, we can take strides towards making sure that high U.S. maternal mortality rates are not considered the status quo.
Mark Simon, M.D., is the Chief Medical Officer at Ob Hospitalist Group (OBHG).