COUNTDOWN TO SUCCESS: THREE YEARS TWO CAMPUSES ONE MOTHER-BABY CARE PROGRAM

Transcription

1 WINTER 2018 COUNTDOWN TO SUCCESS: THREE YEARS TWO CAMPUSES ONE MOTHER-BABY CARE PROGRAM Jeff Poltawsky Sue Erickson Kathy Kostrivas Jamie Limjoco, MD Klaus Diem, MD Igor Iruretagoyena, MD Three years have passed since UnityPoint Health Meriter and UW Health officially formed a single Mother-Baby Care program focused on providing every family and baby that comes to us with the very best and most seamless experience possible. Given all of the great work spanning the past three years, the time seems right to take a global view of where we ve been, where we are and where we re headed. In 2014, the opportunity to form a joint Mother-Baby Care program became increasingly clear, especially after Madison witnessed the opening of its first Level IV NICU at UW Health s American Family Children s Hospital in May of that year. By January 2015, discussions culminated in the signing of a Mother-Baby Care Joint Operating Agreement (JOA) between UnityPoint Health Meriter and UW Health. By leveraging the best practices from each campus and avoiding duplication of high-cost services, we were positioned to grow more effectively together than by remaining separate. The goal was to provide families with the whole spectrum of Mother-Baby Care services, including inpatient obstetrics, normal newborn and midwifery services, high-risk maternal/fetal care, neonatal intensive care (Level III and Level IV) and neonatal transport. Combining simply made perfect sense, not only for our patients but for our ability to grow, says American Family Children s Hospital President Jeff Poltawsky. UnityPoint Health Meriter is the largest birthing center in Wisconsin, offering outstanding care for all babies and great expertise caring for premature babies in its Level III Neonatal Intensive Care Unit (NICU). Meanwhile, our new Level IV NICU made it possible for those babies with the most complex surgical or medical needs to remain close to home in a comprehensive children s hospital, rather than be transferred to a Level IV NICU in Milwaukee, Chicago or Minneapolis. BLENDING TWO CULTURES Integration may have been an easy call in theory, but quite a challenge in practice. As Mother-Baby Care Executive Director Kathy Kostrivas says, it started with building trust. One of the best pieces of advice I got, says Kostrivas, was to avoid speaking in terms of them and us and only say we when it is clear I meant the combined we. Everyone knew there was going to be some anxiety trying to blend two cultures, but we had to start leading the way toward embracing the idea of one program with two campuses. To help break down barriers and facilitate blending of the two organizations, an integration consultant with years of merger experience was hired. Next, an extensive network of stakeholder groups from obstetrics to pediatrics to neonatology to transport was formed. Knowing how vital communication is to successful integration, scores of meetings were held among the 33 stakeholder groups to inform staff of key developments and elicit feedback. At the same time, this Special Delivery newsletter, produced by the Mother-Baby Care communications team, was launched to ensure that staff across both campuses would be regularly updated. -Continued

2 Kostrivas relished the challenge she faced, but admits that it kept her up a few nights too. It is empowering to try and create something new and innovative, says Kostrivas, but it also can be scary knowing how much was riding on it. I was grateful to receive clear direction from our Mother-Baby Care board and invaluable feedback from hospital leadership, physicians, nurses and other staff. NICU COLLABORATION It is no small task to transform two NICUs located 2 ½ miles apart into a virtual entity. Despite strong UW Health physician presence at both locations, the two organizations were competitors with unique cultures. UW Health is an academic enterprise, while UnityPoint Health Meriter is a community hospital. Change can be difficult at first, but once people began to trust and move beyond the them/us dichotomy, it was much easier to focus on what is best for mothers, babies and families. There was a lot of work to be done regarding care coordination, says Jamie Limjoco, MD, neonatal medical director. Our system now ensures that each baby and mother who comes to us gets to the right place to receive the appropriate level of care. In addition, both NICUs have expanded. Six Level III beds were added last year and 12 new Level IV beds will open in With 68 NICU beds in total, we will serve more babies and their families from near and far. Other signs of growth, says Dr. Limjoco, include several recent new hires at UW Health in neonatology faculty members, advanced practice providers and fellows. PRENATAL DIAGNOSTICS AND MATERNAL-FETAL MEDICINE The gateway to Mother-Baby Care, says Klaus Diem, MD, OB medical director, is our robust prenatal diagnostic team. We recently expanded to 9 ultrasound rooms, where we perform more than 15,000 screenings annually. That number, which has been steadily growing, will only increase now that about 800 more deliveries annually will happen at UnityPoint Health Meriter due to an insurance switch in birthing services for members of Group Health Cooperative of South Central Wisconsin. When an ultrasound suggests the possibility of a highrisk pregnancy, expectant mothers typically come to the Center for Perinatal Care at UnityPoint Health Meriter, where more than 800 mothers each year receive care when a problem is discovered with the baby, mother or both. Another transformative accomplishment is the readiness for delivery (via Cesarean section) at American Family Children s Hospital during those rare instances when a baby needs surgery immediately after delivery to survive. Because deliveries had not occurred at UW Health in decades, says Igor Iruretagoyena, MD, Division Chief, Maternal-Fetal Medicine, it was unthinkable for a mother to deliver at AFCH when we launched our Mother-Baby Care program three years ago. Today, we have an incredibly seamless process ready to deploy when we know that it is best for delivery to happen at AFCH. The UnityPoint Health Meriter birthing team, when needed, now travels to the Children s Hospital (or University Hospital if the mother s life is at risk). These occasions are infrequent, says Dr. Igor, but I am so proud of how the entire team bought in because they wanted this collaboration to work. This means that babies who used to leave the community for care now receive the most highly advanced neonatal care closer to home. ACCESS AND TRANSPORT Especially high on the Mother-Baby Care to-do list was creation of a single Access Center, saving referring hospitals from having to guess which hospital to call when a higher level of care is needed. When a baby is in trouble at a community hospital, we want to make it as easy as possible to get him or her to Madison, says Kostrivas. In 2016, we established a single Access Center staffed 24/7 by nurses who quickly facilitate a conversation to determine whether the baby should come to UnityPoint Health Meriter or to American Family Children s Hospital. More than 600 phone calls have been answered during the past 18 months, with 30 percent of the babies coming to Unity Point Health Meriter and 70 percent coming to AFCH. -Continued Page 2

3 Reinforcing the notion that one is more efficient than two, transport of acutely ill babies to either campus is now handled solely by UW Health s CHETA (Children s Hospital Emergency Transport Ambulance) team, which essentially functions as a NICU on wheels until the patient arrives in Madison. In 2018, UW Health s CHETA team will begin helicopter transport service of babies from longer distances than is typically the case with neonatal ground transports (see related article). Referring providers also have access to a wide array of information about transferring a baby to Madison at our newly integrated website: motherbabycare.org LOOKING AHEAD Everyone involved with Mother-Baby Care should feel very proud of what has been achieved in a relatively short time. Looking forward, the program s growth trajectory will rely on bringing more babies to our NICUs and making our care as family-friendly as possible. We will soon begin rolling out Skype-style visits, says Kostrivas, so that mothers and family members who are not in the NICU can see their hospitalized baby on a cell phone, computer or other mobile device. Telemedicine also is slated for a larger role in the coming years, allowing UW Health neonatologists to participate by video in the care of an acutely ill baby hospitalized at Level I, II or III NICUs located throughout the region. *** In July ½ years after the Mother-Baby Care JOA was signed UnityPoint Health Meriter and UW Health agreed to join forces on a much larger scale, signing a broader and deeper joint operating agreement. Combined branding now identifies UW Health as a partner of UnityPoint Health Meriter. Achieving success with Mother-Baby Care integration was a critical step in reaching the full-blown joint operating agreement this past year, says UnityPoint Health Meriter President & COO Sue Erickson. Going from competing with each other to partnering together was not easy, but the Mother-Baby Care example shows how people on each side bought in, trusted one another and kept the patient and family at the center of everything we do. If we can achieve the same thing with the larger JOA, all boats will rise higher and our future position will be stronger. UW Health/UnityPoint Health Meriter Mother-Baby Care Market Share ( nd Quarter) Category Rank in Wisconsin Market Share Obstetrics % Normal newborns % High-risk newborns % Source: Wisconsin Hospital Association MOTHER-BABY CARE ACCOMPLISHMENTS 2017 Thanks to the contributions of so many people across both campuses, our Mother-Baby Care program accomplished much during the past year. Below is a list of highlights: Increased our footprint in the North Wing at UnityPoint Health Meriter to support more patients, our staff and our medical team Moved triage to the 2 nd floor and NICU beds to 3 rd floor at UnityPoint Health Meriter Created a new antepartum space at UnityPoint Health Meriter Added staff to manage new patient growth expected from the Group Health Cooperative contract Started a new NICU Patient and Family Advisory Committee Created a new process for managing Mother-Baby Care calls to the UW Health Access Center Streamlined systems and process for scheduling and responding to the need for cesarean delivery Recertification of UnityPoint Health Meriter as a Baby Friendly Hospital Developed an Outreach Education Department and added two educators to support neonatal and maternal/ob training that includes simulation Created a coordinated process in which the UnityPoint Health Meriter team supports deliveries of the highest risk mothers and surgical neonates at AFCH Developed Mother-Baby Care website to enhance mother-baby referrals from regional providers (motherbabycare.org) Held Perinatal Summit to review and share maternal and neonatal best practices Hosted a Regional Nurse Manager event to support regional nurse education Began developing a Perinatal Database to support quality improvement and research efforts Page 3

4 SPECIAL DELIVERY WINTER 2018 NEONATAL AIR TRANSPORT CAPABILITY EXPANDS NICU PATIENT AND FAMILY ADVISORY COUNCIL FORMED Pictured here are members of the NICU Patient and Family Advisory Council a newly formed group comprised of families whose child was cared for in the AFCH NICU, UnityPoint Health Meriter NICU or both. The council, along with Mother-Baby Care team members, meets quarterly to provide input on patient/family experience initiatives. At the January meeting, the group focused on expanding and improving communication with families when they are first admitted to a NICU. Until now, transport of neonates from the region by air was relatively rare. Later this year, our critical care transport service will begin gradually expanding. A group of neonatology providers has been trained to fly along with the CHETA nurses and respiratory therapists aboard the helicopters. Patients will be considered for transport on a caseby-case basis. Initially, the sickest neonates coming from referring providers who are more than an hour s drive away will be considered for air transport. PERINATAL DATABASE TEAM FORMED REGISTER FOR OUTREACH EDUCATION CLASSES To help achieve our quality improvement and research objectives, a new perinatal database will be created using information from UnityPoint Health Meriter and UW Health. The database will allow for easier access and data extraction for analysis relating to mothers and newborns. Maternal and newborn information will be collected from the Wisconsin birth registry and other sources, and then loaded into an analytic program for reporting and analysis. There are a number of educational programs offered for mother-baby regional and internal audiences. Registration for these classes is now available online and also is accessible on the website: motherbabycare.org. Direction of the new database will come from a new team that includes: Kathy Kostrivas, Dr. Ahmed AlNiaimi, Deb Melanz, Kathy Gollmar, Allan Cooper, Madison Fueling (from the Ancilla group vendor that warehouses data for the state), Brijeet Akula, Kathy Werner, Walter Bredll, Josh Kennedy, Greg Meadus and Dalia Stonys. Page 4

5 BABY MAYVIS DOING WELL AFTER ROUGH START Kim Wiesman of Mosinee, Wisconsin knew before giving birth that she would have some challenges with her new baby, Mayvis. About 10 weeks before Mayvis was born on August 30, 2017, Kim learned from her hometown provider that Mayvis had Down Syndrome as well as a Baby Mayvis serious heart condition known as atrioventricular (AV) canal defect or a large hole in the center of the heart. During her first week of life, Mayvis was admitted to the Aspirus NICU in Wausau because she was not eating. On Day 7, Aspirus contacted the Mother-Baby Care Access Center in Madison. Soon, Mayvis was on her way to American Family Children s Hospital s Level IV NICU, where she spent 44 days. There, another diagnosis explained Mayvis inability to grow - duodenal atresia, a bowel blockage that is often associated with Down Syndrome. UW Health pediatric surgeons Jonathan Kohler, MD and Chuck Leys, MD, relieved the bowel blockage with a minimally invasive operation using three tiny incisions; however Mayvis soon went into heart failure because of the AV canal defect. It was a scary time, says Kim. Our baby had a lot going on. The bowel surgery came first, but Mayvis heart was beating fast, like she was jogging all the time. She needed heart surgery, but not until she gained enough weight to survive that ordeal. Taking food by mouth was too risky, given Mayvis rapid breathing, so Dr. Kohler inserted a gastrotomy tube (G-Tube) into her stomach when she was a month old to help her get enough calories to grow. By early December, at three months of age, Mayvis was ready for heart surgery. On December 7, Mayvis was taken to the operating room, where Petros Anagnostopoulos, MD, director of pediatric cardiothoracic surgery, performed the 6-hour heart repair. It was very nerve-wracking, remembers Kim, but we knew she was in good hands. Ten days later, Mayvis went home. Her breathing and color were much better after surgery, says Kim. She is still feeding through the G-Tube, but speech therapy will help her get to the point where she can start eating normally. Luke Lamers, MD, Mayvis UW Health pediatric cardiologist, will be checking up on her during his pediatric cardiology outreach clinics in Wausau. Given her excellent surgical repair, Dr. Lamers says, Mayvis will most likely never need another heart operation. I expect her to keep growing and do very well. Emily Calonder, Mayvis family nurse practitioner at the Aspirus Weston Clinic near Wausau, appreciates the real-time communication between her clinic and the pediatric specialists in Madison. With both of us using Epic, it is really helpful to see what is going on with Mayvis. I m so pleased to see her breathing normally and smiling more. For Mayvis family, life is slowly approaching a more normal pace. We are so grateful for the exceptional care our entire family received, says Kim. They cared for Mayvis like she was their own child and did everything to make the situation easy and understandable. It was the best case for a worst case scenario. The Wiesman Family includes parents Cody and Kim; Marley, age 2, and Mayvis, age 5 months Page 5