Necessity, as they say, is the mother of invention. Don’t believe it? Just look at the changes to daily life the pandemic has brought to the last two years — many of which are here to stay.
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The need to find new ways of doing things with the potential to create even better outcomes was a driving force in an innovative new program rolled out at SCL’s Lutheran Medical Center and St. Joseph’s Hospital over the past nine months.
The program — a new way of monitoring fetal heartbeat during labor, is already drawing interest from other medical institutions.
According to Deb Lowery, senior director of Women’s Services at both hospitals, it’s also starting to create better, healthier births for moms and babies. Lowery said when babies are born, the delivery is typically scored using something called an APGAR (appearance, pulse, grimace, activity and respiration) scoring system. For example, a score of 10 indicates a great birth with a healthy baby.
Lowery said the hospitals started the OB Hub concept to do better surveillance on babies before they’re born.
She said it often takes more experienced nurses to watch fetal heartbeat patterns and look for nuances a more inexperienced nurse might not catch. But staffing shortages, especially pertaining to more experienced nurses, were making it difficult to make sure every mom-to-be was paired with a nurse with that kind of expertise.
So, drawing from the concept of telemetry floors, her department created the idea of an OB Hub staffed by more experienced nurses 24-hours per day to watch babies’ heartbeats.
“You can actually improve outcomes tremendously if you catch any kind of alteration in the heart rate early,” she said. “And I do believe we’re starting to meet some of our metrics on this and we’re starting to have babies that come out better. So, it really makes our hospitals a safer place for a mom to have a baby.”
As an example of what increased monitoring might find, Lowery said it can be common for babies to have the umbilical cord around their neck in the womb. Usually, she said, that situation doesn’t create a problem. But there can be instances where it could cause a huge drop in heart rate. In this scenario, if the bedside nurse didn’t see the change on the fetal heart rate strip, the more experienced nurse in the hub would be able to call her and make her aware of the situation.
That allows for an appropriate intervention to be weighed and acted upon if necessary. The intervention could be as simple as turning the mom-to-be over to keep her in the optimal position, or, it could mean rushing the patient in for an emergency cesarian section to deliver the baby before the situation causes harm.
“If they (the hub nurses) see something, they’ll call the nurse at the bedside and double check to make sure the in-room nurse is aware of the situation,” she said. “When you have a new graduate nurse in the room, it may take her three or four or even five years until she can read those little subtleties on a fetal monitor strip that say the baby’s starting to get into trouble.”
Jessie Sanchez is a nurse that works in the hub and also on the floor. She said having the hub increases situational awareness and having two sets of eyes has at times made it possible to act on an intervention more quickly than they might have been able to in the past.
According to Lowery, early data from the program indicates its already leading to better APGAR scores. The early success hasn’t gone unnoticed. She said she’s already fielded questions from hospital systems on the east coast and in the south, as well as a major university and small community hospitals, all wanting to know more about the program. Now, the hospitals are preparing a research study to present to a medical journal.
To date, nearly 4,000 babies have been born while being monitored by the hub. Soon, she said, all SCL hospitals in the region will soon be able to participate in the OB Hub program.
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