How should hospitals prepare for the new standards?

As rising rates of maternal mortality have gained national attention, there has been a renewed focus on providing top-quality care for mothers.

This attention is desperately needed: According to the latest numbers, the U.S. maternal mortality rate climbed to nearly 30 deaths for every 100,000 mothers giving birth—double the mortality rate of other first world nations. What’s more, an estimated 60% of these deaths are preventable.

Minority women, in particular, are disproportionately impacted in the U.S.: black women are three times more likely to die, and American Native and Alaskan women are more than twice as likely to die around the time of childbirth than white women.

Policymakers have taken notice of the urgent need for action, initiating measures at both the state and federal level to identify evidence-based interventions and strategies that can help to reduce these numbers.

But there are also significant measures being taken by the medical community. With rising concerns about the growing maternal mortality rates in the U.S., many hospitals are adopting evidence-based practices and protocols to prevent more tragedies from occurring.

New Joint Commission "elements of performance"

The Joint Commission currently accredits and certifies over 22,000 health care organizations throughout the U.S. The Joint Commission accreditation is not only viewed as a distinguishing symbol of approval for quality and safety standards but is also a requirement for organizations participating in certain types of insurance reimbursement and managed care plan contract participation.

Last year, the Joint Commission issued a report introducing two new standards that address maternal hemorrhage complications and severe hypertension/preeclampsia.

Starting in July 2020, the Joint Commission will require hospitals to meet 13 new “elements of performance” (EPs) related to maternal health as part of the accreditation requirements. (Note that the Joint Commission decided to delay implementation of the new safety standards until January 1, 2021). This includes new standards for using prevention, early recognition, and timely treatment to address maternal hemorrhage complications and severe hypertension/preeclampsia, two of the most common causes of pregnancy-related deaths.

Some of the specific recommendations will require hospitals to:
• Develop written, evidence-based procedures to identify and treat the conditions
• Stock easily accessible hemorrhage supply kits
• Provide role-specific education to all staff and providers who treat pregnant/postpartum patients at least every two years
• Conduct response procedure drills at least annually
• Educate patients on signs and symptoms that warrant care during hospitalization and after discharge

OB hospitalists, while not specifically identified in the new requirements, are uniquely positioned to support hospitals’ implementation of the EPs. For example, OB hospitalists can actively collaborate with leadership teams at their partner hospitals to assess current efforts and confirm understanding of the Joint Commission standards, including sharing best practices about the new standards across their network of hospital partners; serving as onsite subject matter experts for hospital partners in understanding and meeting the new standards; and providing clinicians with regular, comprehensive training on maternal emergencies.

In close coordination with the assigned provider, OB hospitalists can also take the lead role in educating patients at discharge on postpartum complications related to hemorrhage, hypertension, preeclampsia and other conditions identified in The Joint Commission requirements. An OB hospitalists’ unique onsite position allows them to take as much time as needed to ensure patients fully understand warning signs and the need to return for emergency care quickly.

Preparing for the new standards

At Ob Hospitalist Group, we’re continuing to have conversations with hospitals across the country regarding the new EPs. Through our role, we are helping to educate hospitals to ensure they are compliant with the new standards before the implementation date.

Other ways we are helping hospitals include gap analyses to review where hospitals are meeting the standards and where there are gaps, and implementation of drills and simulations regarding hemorrhage and hypertension.

Reducing maternal mortality rates is a team effort and will require a commitment by both hospital leaders and providers across the full spectrum of obstetric care to make significant sustainable differences.

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