The American Hospital Association and EHR giant Epic have released a postpartum hemorrhage toolkit aimed at improving maternal health outcomes, saying they will connect providers with expertise to integrate point-of-care tools into EHR workflows.
The tools have been shown to enhance a hospital's ability to prevent and manage PPH, a potentially life-threatening complication of childbirth, and decrease obstetric hemorrhage rates.
WHY IT MATTERS
PPH, the primary cause of maternal morbidity, impacts 3-5% of all deliveries and is responsible for 11.2% of maternal deaths in the United States, AHA and Epic said in their joint announcement on Thursday.
Substantial and swift blood loss leads to a perilous drop in blood pressure that can cause organ failure or even death. However, patients without prior risk factors comprise 40% of PPH cases, a factor that contributes to the country's severe maternal morbidity rate.
Reacting quickly to signs of PPH could be the difference between life and death for postpartum patients.
Continuous risk assessment, which relies on a free-to-use algorithm developed by the Association of Women’s Health, Obstetric and Neonatal Nurses, refreshes throughout childbirth and postpartum in Epic's Stork Obstetrics Information System labor and delivery workflows. Also available within the EHR is clinical decision-making guidance within defined risk categories to facilitate treatment of acute hemorrhage.
"According to clinicians, the PPH risk assessment should be done at admission, at the start of the second stage of labor, upon transfer to postpartum care and whenever the patient’s condition changes," AHA said in its report on the new toolkit. "These assessments categorize patients into low-, medium- and high-risk categories, providing recommendations for medications and other supplies to prevent and treat hemorrhage within each risk category."
To optimize PPH functionality, algorithm integration should begin with admission workflows to ensure automatic score updates while the maternity patient is in the hospital's care, according to the report. Functionality also requires configuring the EHR to display incomplete assessment notifications, highlight PPH risk scores on patient summaries and dashboards, and automatically recommend necessary supplies for medium and high-risk patients.
The AHA Patient Safety Initiative and Epic will use joint programming, resources and a platform for peer learning to raise awareness of the new tools, they said. While Epic pledged to support customer hospitals throughout the implementation, the AHA noted that users of any EHR can implement similar tools.
The collaboration amplifies the hospital organization's efforts to share evidence-based resources that can improve outcomes, Dr. Chris DeRienzo, AHA's chief physician executive, noted in the statement.
"It’s a natural extension of AHA’s Patient Safety Initiative, a collaborative data-driven effort to highlight and learn from patient safety progress at hospitals and health systems around the country," he said.
The AHA said it plans to facilitate engagement with hospitals experiencing successful outcomes, including Baptist Health in Arkansas, which implemented the PPH toolkit in three phases. Baptist integrated AWHONN's postpartum risk assessment tool and a blood loss calculator within its EHR. Staff were then reportedly trained to use them in patient hemorrhage drills.
WakeMed Health & Hospitals in Raleigh, North Carolina, also has been using the tools for nearly three years and has observed a consistent decrease in obstetric hemorrhage rates.
THE LARGER TREND
Various research organizations, including Mayo Clinic, have been working with machine learning to reduce adverse birth outcomes and maternal morbidity rates.
Three years ago, the health system's researchers said they found artificial intelligence made it possible to predict how labor patterns can help identify whether a vaginal delivery will have good outcomes for mother and baby. The models could predict the probability of poor labor outcomes from active labor dilation data, including cesarean delivery in active labor, postpartum hemorrhage, intra-amniotic infection, shoulder dystocia, and neonatal morbidity and mortality.
AI has also helped make maternal ultrasounds widely accessible and improve their accuracy. Sophisticated analyses can help clinicians measure fetal biometrics, identify anomalies and provide more precise diagnoses. The models also analyze large volumes of data quickly, making prenatal care more effective across populations.
ON THE RECORD
"Every mother deserves a safe childbirth experience," Dr. Jackie Gerhart, Epic's chief medical officer, said in a statement. "The goal of our joint effort is to help caregivers act quickly when every second counts."
"This new collaboration amplifies our efforts to drive continuous improvement by sharing evidence-based resources to help reduce this tragic condition," DeRienzo added.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
