Consultation, Surveillance, Monitoring, and Intensive Care (COSMIC): A Novel 4-Tier Program to Identify and Monitor High-Risk Obstetric Patients From the Clinic to Critical Care

Lockhart, Evelyn; Hincker, Alexander; Klumpner, Thomas T.; Hofer, Jennifer; Cahill, Alison G.; Palanisamy, Arvind; Boyle, Walter; Ginosar, Yehuda

doi:10.1213/ane.0000000000004141

Cited by 8 publications

(3 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although most of the women giving birth are healthy, obstetrics can be regarded to be a high-risk area [14]. The majority of women do not require classic treatment of chronic or acute disease, but a large number of women may need routine medical support during labor such as pain relief, anesthesia, treatment, or prevention of infections.…”

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators of Safe Communication in Obstetrics: Results from Qualitative Interviews with Physicians, Midwives and Nurses

Schmiedhofer

Keller

Dietl

et al. 2021

IJERPH

View full text Add to dashboard Cite

Patient safety is an important objective in health care. Preventable adverse events (pAEs) as the counterpart to patient safety are harmful incidents that fell behind health care standards and have led to temporary or permanent harm or death. As safe communication and mutual understanding are of crucial importance for providing a high quality of care under everyday conditions, we aimed to identify barriers and facilitators that impact safe communication in obstetrics from the subjective perspective of health care workers. A qualitative study with 20 semi-structured interviews at two university hospitals in Germany was conducted to explore everyday perceptions from a subjective perspective (subjective theories). Physicians, midwives, and nurses in a wide span of professional experience and positions were enrolled. We identified a structural area of conflict at the professional interface between midwives and physicians. Mandatory interprofessional meetings, acceptance of subjective mistakes, mutual understanding, and debriefings of conflict situations are reported to improve collaboration. Additionally, emergency trainings, trainings in precise communication, and handovers are proposed to reduce risks for pAEs. Furthermore, the participants reported time-constraints and understaffing as a huge burden that hinders safe communication. Concluding, safety culture and organizational management are closely entwined and strategies should address various levels of which communication trainings are promising.

show abstract

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators of Safe Communication in Obstetrics: Results from Qualitative Interviews with Physicians, Midwives and Nurses

Schmiedhofer

Keller

Dietl

et al. 2021

IJERPH

View full text Add to dashboard Cite

show abstract

“…The study by Lockhart et al found that telemedicine assisted in the diagnosis of high-risk pregnant women and the alternatives to remote ICU greatly improved the accessibility of ICU treatment management. 28 Our study has several limitations. First, the study will be implemented in a single setting with high capability of clinical care in urban areas, which would limit the generalisation of the findings.…”

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Reduced-visit antenatal care model combined with telemedicine for low-risk pregnant women: protocol for a randomised controlled trial

Shi,

Wang,

Dang

et al. 2023

BMJ Open

View full text Add to dashboard Cite

IntroductionAntenatal care (ANC) is a critical measure to reduce maternal and perinatal morbidity and mortality. However, there are issues of too many visits and cumbersome procedures of ANC in many maternity hospitals of China. In the past 2 years, reduced-visit ANC models combined with remote monitoring have been recommended and implemented at most hospitals in China during the COVID-19 pandemic. Nevertheless, due to limited evaluations of the cost-effectiveness, policy-makers remain confused on how to appropriately integrate online delivery strategies with routine models to improve ANC quality and efficiency sustainably at scale. This trial aims to evaluate the effectiveness, acceptability and cost of a reduced-visit ANC model combined with telemedicine.Methods and analysisA single-blind, randomised controlled trial will be conducted among low-risk pregnant women at Peking University Third Hospital in Beijing. 1476 patients (738 in each group) would be required, and they will be randomly assigned in a 1:1 ratio to receive the reduced-visit ANC combined with telemedicine services or the routine ANC. The primary outcome is the composite rate of adverse maternal and perinatal outcomes which will be extracted from the medical records. Secondary outcomes include acceptability of ANC models, which is assessed by satisfaction with ANC, pregnancy-related stress and ANC costs measured from the perspectives of both service providers and demanders. Both intention-to-treat and per-protocol analyses will be performed. Non-inferiority tests will be used to compare the two ANC models for the primary outcome. A cost-effectiveness analysis comparing the two ANC models will be conducted by estimating the incremental cost-effectiveness ratios.Ethics and disseminationThis study was approved by the ethical review committee of the Peking University Third Hospital (Beijing, China). The results of this study will be published in peer-reviewed scientific journals and presented at relevant academic conferences.Trial registration numberNCT05290467.

show abstract

Design, construction, and validation of obstetric risk classification systems to predict intensive care unit admission

Soares,

da Rocha Carvalho Rosa,

Cecatti

et al. 2024

Intl J Gynecology & Obste

View full text Add to dashboard Cite

IntroductionTo develop and validate a support tool for healthcare providers, enabling them to make precise and critical decisions regarding intensive care unit (ICU) admissions for high‐risk pregnant women, thus enhancing maternal outcomes.MethodsThis retrospective study involves secondary data analysis of information gathered from 9550 pregnant women, who had severe maternal morbidity (any unexpected complication during labor and delivery that leads to substantial short‐term or long‐term health issues for the mother), collected between 2009 and 2010 from the Brazilian Network for Surveillance of Severe Maternal Morbidity, encompassing 27 obstetric reference centers in Brazil. Machine‐learning models, including decision trees, Random Forest, Gradient Boosting Machine (GBM), and Extreme Gradient Boosting (XGBoost), were employed to create a risk prediction tool for ICU admission. Subsequently, sensitivity analysis was conducted to compare the accuracy, predictive power, sensitivity, and specificity of these models, with differences analyzed using the Wilcoxon test.ResultsThe XGBoost algorithm demonstrated superior efficiency, achieving an accuracy rate of 85%, sensitivity of 42%, specificity of 97%, and an area under the receiver operating characteristic curve of 86.7%. Notably, the estimated prevalence of ICU utilization by the model (11.6%) differed from the prevalence of ICU use from the study (21.52%).ConclusionThe developed risk engine yielded positive results, emphasizing the need to optimize intensive care bed utilization and objectively identify high‐risk pregnant women requiring these services. This approach promises to enhance the effective and efficient management of pregnant women, particularly in resource‐constrained regions worldwide. By streamlining ICU admissions for high‐risk cases, healthcare providers can better allocate critical resources, ultimately contributing to improved maternal health outcomes.

show abstract

Consultation, Surveillance, Monitoring, and Intensive Care (COSMIC): A Novel 4-Tier Program to Identify and Monitor High-Risk Obstetric Patients From the Clinic to Critical Care

Cited by 8 publications

References 16 publications

Barriers and Facilitators of Safe Communication in Obstetrics: Results from Qualitative Interviews with Physicians, Midwives and Nurses

Barriers and Facilitators of Safe Communication in Obstetrics: Results from Qualitative Interviews with Physicians, Midwives and Nurses

Reduced-visit antenatal care model combined with telemedicine for low-risk pregnant women: protocol for a randomised controlled trial

Design, construction, and validation of obstetric risk classification systems to predict intensive care unit admission

Contact Info

Product

Resources

About