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OBSTETRICS: C-section rate expected to be 27 to 30 percent

The rate of cesarean deliveries is currently around one-third of all deliveries in the U.S. and is expected to remain in the range of 27 to 30 percent for the near term.  In about 15 years, the rate may drop to 20 to 25 percent.  Factors responsible for the continued “upward pressure” on the C-section rate include maternal age, obesity and diabetes.

Source: Clapp, M.A., and Barth, W.H., Jr. (2017, December). The future of cesarean delivery rates in the United States. Clinical Obstetrics & Gynecology, 60(4), 829-839.  Click here for publisher’s website: http://journals.lww.com/clinicalobgyn/Abstract/2017/12000/The_Future_of_Cesarean_Delivery_Rates_in_the.17.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OPIOIDS: Hospital reinvents care model for NAS infants

Neonatal abstinence syndrome (NAS) refers to a withdrawal period that newborns must undergo if they have been exposed to opioids prenatally.  This study was conducted at Cabell Huntington Hospital in Huntington, WV, which is located in an area of the country with a high rate of opioid use.  At the beginning of the study period, newborns with NAS were treated in the 36-bed Level III neonatal intensive care unit at the hospital.  In mid-2012, a new unit was opened at the hospital – a 15-bed neonatal therapeutic unit (NTU) with low lights and low noise and volunteers to rock the babies.  In late 2014, a 12-bed offsite version of the NTU called Lily’s Place was opened.

Comparing Median Charges in These 3 Settings

  • $90,601 (NAS infants cared for in the NICU)
  • $68,750 (NAS infants cared for in the NTU)
  • $17,688 (NAS infants cared for at Lily’s Place – and this figure includes a brief stay in the NTU)

Sources:

Loudin, S., and others. (2017). A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic. Journal of Perinatology, 37, 1108-1111.   Click here for FREE OPEN ACCESS: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633652/pdf/jp2017101a.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Lily’s Place video here: https://youtu.be/xoAPKF-mOfM

NICUs: What is a small baby unit?

Small baby units take the neonatal intensive care unit (NICU) concept to a new level by specializing in the care of the smallest babies – known as micro-preemies – born at fewer than 27 weeks gestation and/or weighing less than 1,000 grams (2.2 pounds).  The design of the units, which are part of a larger NICU, includes providing a dark, quiet environment.  Parents are encouraged to participate in skin-to-skin care (SSC) techniques that fosters bonding, such as Kangaroo Mother Care.  Caregivers are teamed up to deliver two-person care when the micro-preemies need to be touched.  As the babies grow, they may be transitioned out of the small baby unit to the NICU.

Hospitals with Small Baby Units (this is not a comprehensive list)

  • Advocate Lutheran General Hospital (Park Ridge, IL)
  • Children’s Hospital (Orange, CA)
  • Greenville Health System (Greenville, SC)
  • Helen Devos Children’s Hospital (Grand Rapids, MI)
  • Mercyhealth Hospital-Rockton Avenue (Rockford, IL)
  • Nationwide Children’s Hospital (Columbus, OH)

Sources:

Gonya, J., and others. (2017). Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: A retrospective cohort study. BMJ Open, 7.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372108/pdf/bmjopen-2016-012985.pdf

GHS launches NICU small baby unit. (2017, May 12). WSPA-TV. http://wspa.com/2017/05/12/ghs-launches-nicu-small-baby-unit/

Jackson, A. (2015, December 9).  Born at 25 weeks weighing less than 2 pounds, ‘spunky’ girl survives in small baby unit. MLive. http://www.mlive.com/news/grand-rapids/index.ssf/2015/12/small_baby_nicu_at_devos_child.html

Morris, M., Cleary, P., and Soliman, A. (2015, October). Small baby unit improves quality and outcomes in extremely low birth weight infants. Pediatrics, 136(4).  http://pediatrics.aappublications.org/content/pediatrics/136/4/e1007.full.pdf

Watley, K. (2017, February 6). Mercyhealth in Rockford opens region’s first small baby unit to care for micro-preemies. https://mercyhealthsystem.org/mercyhealth-opens-small-baby-unit-rockford/

Woloshyn, E. (2017, April 20). Special unit mimics mother’s womb. Health enews.

http://www.ahchealthenews.com/2017/04/20/special-unit-mimics-mothers-womb/  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

BEST PRACTICES: Implementing a quality improvement bundle for care of high risk infants in the delivery room

This was a case study of 548 high-risk infants born 2010 to 2012 at Palomar Medical Center (Escondido, CA) who were then transferred to the neonatal intensive care unit at Palomar Rady Children’s Hospital (San Diego).  About half of the infants were born before implementation of an quality improvement project intended to standardize delivery room management – a preintervention group.  The merits of each of the changes in practice – such as a significant decrease in intubation – are discussed.  A delivery room checklist is included.

Source: Sauer, C.W., and others. (2016, November 16). Delivery room quality improvement project improved compliance with best practices for a community NICU. Scientific Reports, 6, 37397.  Click here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116615/pdf/srep37397.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BENCHMARKS: Space planning in labor and delivery

This is a rule-of-thumb provided by Hayward & Associates, a health care facility planning firm, that may be used to plan for a labor and delivery area.  In the following ratios, LDR means labor-delivery-recovery.  LDRP means the same except adds a postpartum stay in the same room – this is also known as single-room maternity care.

Space planning based on annual births

  • 100 to 200 births / LDRP room if the LDRP concept is used exclusively
  • 300 to 400 births / LDR or LDRP room if some patients are moved to a separate postpartum room after discharge

Recommended departmental gross square feet (DGSF) and departmental gross square meters (DGSM) are also given in this brief article.

Source: Hayward, C. (2017, Spring-Summer). Obstetrical services capacity and preliminary space need. SpaceMed Newsletter. Click here: https://www.spacemed.com/newsletter/rule-102-ob.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OBSTETRICS: Reasons OB units close in rural areas

The reasons why rural hospitals closed their labor and delivery services were studied based on a telephone survey of hospitals in nine states.  Of the 263 hospitals that responded, 19 (or 7.2 percent) closed their OB units during the study period of 2011 to 2014.  Here are the reasons that were identified as risk factors for closing:

  • Low birth volume
  • Private (as opposed to public) ownership of the hospital
  • Low number of family physicians practicing in the area
  • Low income surrounding area

Source: Hung, P., and others. (2016, August). Why are obstetrics units in rural hospitals closing their doors? HSR. Health Services Research, 51(4), 1546-1560.  Click here for publisher’s website: http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12441/full  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OBGYN: Providing prenatal care in group visits

The idea of seeing expectant mothers who are at about the same stage of pregnancy together in a group for prenatal care is not new – it was described in the 1990s.  Generally, it is for low-risk patients.  Mazzoni & Carter discuss findings in the literature as to the effectiveness of this approach.  A popular model is called Centering Pregnancy, which is addressed in the other articles cited below.

Selected Sources:

Mazzoni, S.E., and Carter, E.B. (2017, February 9). Group prenatal care. American Journal of Obstetrics and Gynecology.  Click here for the publisher’s website: http://www.ajog.org/article/S0002-9378(17)30185-0/pdf

Crockett, A.H., and others. (2017, January). The South Carolina centering pregnancy expansion project: Improving racial disparities in preterm birth. American Journal of Obstetrics and Gynecology. 216(1 Supplement), S424-S425. Click here for free full text: http://www.ajog.org/article/S0002-9378(16)31441-7/pdf

Carter, E., and others. (2016, January). Group compared to traditional prenatal care for optimizing perinatal outcomes: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 215(1 Supplement), S382.  Click here for free full text: http://www.ajog.org/article/S0002-9378(15)02081-5/pdf

Garretto, D., and Bernstein, P.S. (2014, January). Centering Pregnancy: An innovative approach to prenatal care delivery. American Journal of Obstetrics & Gynecology, 210(1), 14-15.  Click here for free full text: http://www.ajog.org/article/S0002-9378(13)01039-9/pdf

Fausett, M., and others. (2014, January). Centering Pregnancy is associated with fewer early, but not overall, preterm deliveries. American Journal of Obsetrics & Gynecology, 210(1, Supplement), S9.  Click here for free full text: http://www.ajog.org/article/S0002-9378(13)01111-3/pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org