Doctor examining a pregnant woman on white background
Ob-Gyn

Einstein Has City’s Lowest Complication Rate for Women Giving Birth

By on 08/12/2019

Einstein Medical Center Philadelphia is a remarkably safe place for pregnant women to give birth, a recently published independent analysis shows.

According to statistics compiled by the newspaper USA Today, Einstein Philadelphia has by far the lowest rate of serious maternal complications of any hospital in Philadelphia. It’s well below the state average as well.

These results were achieved even though communities around Einstein face high rates of health challenges such as obesity, diabetes, and poverty.

Einstein’s rate, one-half of 1% (0.5%), is less than half that of the next lowest hospital in the city, hospital profiles published in the newspaper show. Einstein’s rate is also less than half the Pennsylvania state average of 1.1%. Rates at other Philadelphia hospitals ranged from 1.3% to 3.3% Figures were based on data from the Pennsylvania Cost Care Containment Council, a state agency.

“We are very proud of these results, but more so we are honored that families trust us to care for them,” says David Jaspan, DO, Chairman of Obstetrics and Gynecology for Einstein Healthcare Network.

What Is Serious Maternal Morbidity?

Known collectively as serious maternal morbidity (SMM), maternal complications are serious medical problems that can develop for a woman just before, during, or soon after childbirth. They include blood transfusions resulting from severe blood loss (hemorrhage), blood clots, breathing problems, kidney failure, and preeclampsia, a condition that begins with very high blood pressure and can lead to seizures and even death.

The U.S. Centers for Disease Control and Prevention (CDC) says that nationwide SMM rates per 10,000 births almost tripled between 1993 and 2014. This trend is believed to be related to an increase in births to older mothers, as well as higher rates of obesity, diabetes and other medical conditions among young women. All of these can increase the risk of problems in childbirth.

At Einstein Philadelphia, maternal morbidity rates have been declining since 2014.

It didn’t happen by accident. It happened because of a series of deliberate, thorough and focused initiatives, Dr. Jaspan says. All of them were aimed at identifying and addressing promptly any potential issues that could affect a pregnant woman’s safety.

“It was approximately six years ago when we began to look at this,” Dr. Jaspan says. “We decided that we wanted to create the safest place for patients to have care.”

Everyone Encouraged to Speak Up

A team representing multiple departments set to work. Some of the changes were sweeping. One of the most important was training and encouraging everyone who encounters a patient to notice and speak up about anything that could cause harm or just be improved. That includes not just the obstetrics doctors and nurses but also the people who transport patients, prepare meals, and clean rooms.

“Every concern is taken seriously and investigated,” Dr. Jaspan says. “It’s all about making patients safer. It sounds simple, but it’s empowering. We wanted to create that culture and make it pervasive throughout our buildings.”

That culture change has resulted in suggestions and interventions by nurses, operating room technicians, transportation staff and others who noticed potential issues and brought them to light.

The hospital also has adopted measures to reduce cesarean section rates, which in turn reduces the risk of complications from surgery. Read more about programs that have reduced C-sections at Einstein Philadelphia.

Empowerment Through Prenatal Care

Even prenatal care has changed. Einstein’s CenteringPregnancy® program has played an important role, Dr. Jaspan says. This care model, which is optional for patients, includes group educational sessions.

“It has been very helpful to work with the patients to improve their health-care literacy,” he says, “and enabling patients to be their own best advocate and enabling patients and families to speak up.”

Other changes were detailed and procedural, such as:

  • Improving the “triage” system for the 750 pregnant women who come to the hospital each month with any kind of concern
  • Making sure that best practices for prenatal and maternity care – those confirmed by research – are identified and followed consistently
  • Improving communications among senior doctors, residents, nurses and patients to make sure that any concerns are addressed
  • Responding quickly to data about any potentially worrisome trends in patient outcomes
  • Making many small improvements in processes that allow staff to notice and respond quickly to any changes in a patient that could signal a problem

A Better Triage System

The main change in the triage system was to make sure that pregnant women who come to the hospital get a quick evaluation. Then what happens next depends on their complaint, their stage of pregnancy, their vital signs, and a quick check of the baby.

“If you come in and you stubbed your toe, what happens to you should be very, very different than if you come in with abdominal pain,” Dr. Jaspan says.

The program has been very successful, he says. “It gets the person who’s most critically ill evaluated in the shortest period of time.”

The changes that have helped to minimize the serious maternal morbidity rate have come despite many challenges facing the community around Einstein Philadelphia that can affect women’s health. About 88% of the women giving birth at the hospital are low-income, insured by Medicaid, Dr. Jaspan says. About 56% are African-American. Both these groups have higher maternal morbidity rates than national averages.

USA Today’s survey of hospitals in 13 states found that low-income mothers had a 36% higher rate of serious complications than the median rate for those states. Black women had an 86% higher rate.

Equal Care for Black and Low-Income Women

At Einstein, however, the serious complications rates for all obstetrics patients and low-income patients were identical, 0.5%. Rates for black women were a bit higher, 0.6%. All of Einstein’s numbers were less than half of the medians for Pennsylvania and the 13 states surveyed by the newspaper.

Einstein Medical Center Montgomery, which treats a suburban population with fewer low-income and black patients, had a 0.3% rate of serious maternal morbidity, according to USA Today.

The treatment of black women – including wealthy black women – during pregnancy and childbirth was in the spotlight recently because of interviews with tennis great Serena Williams and chart-topping singer Beyoncé about serious complications they had during childbirth in 2017.

Both women gave birth by emergency C-section. Beyoncé developed pre-eclampsia and was on bed rest for a month.

Williams, who has a history of blood clots, told Vogue magazine that hospital staff didn’t take her seriously at first when she said she needed a CT scan and heparin, an anti-clotting drug, because of shortness of breath. Tests showed that she did have clots in her lungs. While taking drugs to prevent clots, she later hemorrhaged in the hospital.

“We treat every patient based on what her complaint is, not the color of her skin or socioeconomic class,” Dr. Jaspan says. “I think that it’s a matter of enabling patients to feel comfortable communicating and being their own advocate, and responding and giving the patient the ability to have her words heard.”

Special Programs for High-Risk Pregnancies

Many Einstein Philadelphia patients also fall into the category of “high risk” pregnancies because of high rates of medical conditions such as obesity, diabetes, and high blood pressure. 

Einstein has taken steps to reduce their risk by closely coordinating women’s maternity care and other care, Dr. Jaspan says. “In our high-risk clinic, we have brought services into our offices for HIV management, mental health services, and cardiology, so they don’t need to go elsewhere.”

The hospital also works with patients to identify and remove any barriers that might keep them from keeping their appointments or filling prescriptions, Dr. Jaspan says. The obstetrics department also is using telemedicine to reduce the need for appointments for patients who might have trouble getting to them.

No doubt other changes lie ahead. “We will continue to evolve and learn and adopt new strategies to enhance the care that we are able to provide,” Dr. Jaspan says.

Read more about how these low complication rates were achieved.

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