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The Center for Peripartum Optimization: An Innovative Approach to Care Coordination
Abstract Number: S1C-3
Abstract Type: Case Report/Case Series
Over the last 30 years, pregnancy-related deaths have more than doubled in the United States secondary to more parturients with complex medical comorbidities. We aim to provide care for all high-risk obstetric patients and patients with complex anesthetic histories at our institution.
We developed a Center for Peripartum Optimization (CPO) using a two-stage process mapping procedure. In the first stage, the departments of Anesthesiology, Gynecology and Obstetrics, Hematology, and Cardiology synchronized patient scheduling and developed a process for transfer of administrative and clinical information. In the second stage, the administrative team established a process map for patient progress through the system. Finally, we benchmarked resource requirements and clinical work outputs for each provider.
Our CPO became operational in January 2017. High-risk patients are identified based on specific criteria and are seen in one of our outpatient clinics. Based on the patient’s medical issues and needs, care is coordinated with the Obstetrics and Gynecology team and/or other specialties and may include additional testing, evaluation, and subspecialty consultation before admission. After all necessary information has been obtained, the CPO and obstetric team formulate a roadmap for the labor and delivery team, including obstetricians, anesthesiologists, and
nurses, to reduce the risk from poor continuity of care often associated with handoffs.
We anticipate that optimizing a patient’s clinical status in an outpatient setting will minimize unnecessary laboratory tests and studies, costly inpatient consultations, and inpatient admissions and reduce the likelihood of post-surgical adverse events, escalations in level of care, and readmissions for certain patient populations. We also anticipate reductions in opioid utilization and improved patient and family satisfaction. We intend to extend the program into the surrounding health communities to coordinate care, reduce unnecessary outside hospital transfers, and facilitate early transfer of antepartum patients who require higher levels of care.
1. Molina RL, Pace LE. A renewed focus on maternal health in the United States. N Engl J Med 2017;377:1705-7.
Additional references available upon request.