A new initiative at the University of Arkansas for Medical Sciences is working to make sure emergency rooms across the state are better prepared. Ozarks at Large’s Sarah Laiche has more.
For most people, a trip to the emergency room can already be really stressful. But for pregnant and postpartum women, that stress can be amplified by a lot of possible complications. Jennifer Callaghan-Koru is an associate professor in the College of Public Health at the University of Arkansas for Medical Sciences. She’s also the executive director of the Arkansas Perinatal Quality Collaborative or ARPQC; a statewide network focused on improving care for mothers.
Callaghan-Koru says their work often starts with a pretty simple question: where are we at now?
“Where were we starting? What were the practices related to identifying and managing obstetric complications in the emergency department, and what types of trainings had emergency department providers received in Arkansas so that we could identify the areas where we needed to focus.”
And what they found started to raise some concerns. UAMS and the ARPQC conducted a survey of emergency departments across the state and found that there were many areas for improvement. She says most emergency departments routinely ask whether a patient is pregnant.
However, less than half of the departments surveyed were consistently asking about postpartum status. It’s really important to screen for postpartum status because serious complications can occur well after delivery. She says that timeline can be as long as a full year after a pregnancy ends.
“So there are complications that are much more likely to occur in the early postpartum period, such as the first six weeks. But then there are things, for example, cardiac, um, conditions related to pregnancy that can occur later. And so it's important to be assessing for the full year after pregnancy.”
Conditions like pregnancy-related hypertension or pre-eclampsia can develop in that 12-month period after delivery. The survey also found that less than half of Arkansas emergency departments had received any training on any obstetric emergencies in the past two years. One emergency that occurs in about 40% of emergency departments is precipitous birth. This is when labor lasts less than three hours. Callaghan-Koru says that this rapid labor can be concerning, especially with the national trend towards the closure of labor and delivery units.
“And particularly a patient who might live in a rural area, it's harder to travel to a hospital with a labor and delivery unit that might end up needing to go to the emergency department if they have a really rapid onset labor. So that's something that emergency departments we're seeing rather regularly. And it's also something that the physicians and nurses working in emergency departments they're very nervous about. They want to make sure that they're prepared because they know it can happen.”
The Arkansas Perinatal Quality Collaborative launched trainings across the state in response to these possible emergencies. The training includes presentations and hands-on simulations. They use mannequins to present maneuvers to assist with precipitous birth and to demonstrate what elevated blood pressure or a seizure can look like in a patient with preeclampsia.
“We've been doing trainings for about two years now. We have obstetricians who are expert trainers who are traveling to emergency departments across the state. So we have had really strong interest and end up with a wait list of emergency departments, but we work really hard to get to all of them that want to have training. And we've done trainings at professional conferences. So EMS conferences and nursing conferences where we make ourselves available for providers who are attending those trainings as well.”
The response has been very positive. Callaghan-Koru says hospitals are not only requesting the training- they’re actually changing how they operate afterward.
“So we’ve had a really strong response from both the management who are the ones who are organizing the trainings and inviting us to come. And then we've also had really positive response from the staff who, right now we're doing a follow up interviews with emergency departments that we trained about a year ago and are hearing from them that they're making policy and practice changes, that the staff have a much higher awareness of what some of the obstetric emergencies they might encounter are, and how to identify them and manage them. For example, pregnancy-related hypertension in the postpartum period that they might have missed and not treated in the recommended way if they hadn't had the training recently.”
This new training has already made a difference in some cases. It’s helping providers recognize and treat those pregnancy-related complications that might have otherwise gone unnoticed. Callaghan-Koru says that collaboration is key in this program. Hospitals across Arkansas meet regularly to learn from one another and share what’s working.
“So every single hospital is an equal partner in this work. We're meeting on a regular basis every month. They're sharing the work that they're doing, the innovations that they come up with to help address their patients’ needs. And that's what we want to do. We want to be spreading really good ideas that help the health care providers and their patients. And that's one of the most powerful things about quality improvement collaboratives is that peer-to-peer sharing.”
Callaghan-Koru moved to Arkansas about four years ago to help build the Perinatal QualityCollaborative, something that didn’t previously exist here in Arkansas. She says there have been huge strides in recent years towards improving maternal care.
“I would say the past two years, maybe the right word would be a renaissance in terms of maternal health in particular. There's been a lot of innovative, um, attention to the issue that wasn't here my first two years in Arkansas. Then, willingness to take some innovative approaches to try to address challenges.”
She says the last few years have brought renewed attention to maternal health statewide, especially as rural hospitals face closures and access to care becomes more and more limited.
“And that's one of the reasons that we focused on this obstetric emergency preparedness and emergency departments. A lot of the ARPQC’s work is with birthing hospitals, but we know that the emergency departments are a place where women can seek care, and they might not be prepared without the support and training.”
If you’re interested in learning more, Callaghan-Koru points to two public resources: first the ARPQC website, which includes a map of birthing hospitals and services offered, and the Arkansas Maternal Health Scorecard, which tracks maternal health outcomes across the state. Both are tools aimed at increasing awareness and ultimately, saving lives.
