17 Mar

Patient deterioration #2 patient safety concern

ECRI Top 10 Patient Safety Concerns for Healthcare Organizations

ECRI Institute Releases Annual

Top Ten Patient Safety Concern List

Based both on analysis of 1.5 million event reports from the patient safety organization database and a review of those representing high priorities because they are new, changing or persistent, the ECRI Institute’s Top 10 Patient Safety Concerns for Healthcare Organizations has become a staple for teams looking to focus their patient safety improvement programs on the most pressing of problems.

Our interest in the following concerns should come as no surprise.  They are,after all, those that we can help hospitals with:

#2: Unrecognized Patient Deterioration

#3: Implementation and Use of Clinical Decision Support

#10: Inadequate Organization Systems or Processes to Improve Safety and Quality

The link between PeriGen’s software and helping labor & delivery clinicians recognize and respond to patient deterioration is a no-brainer.  It’s what our neural-network based clinical analytic tools that offer both pattern recognition and protocol compliance management are designed to do.  Our latest tool, HUB, is an early warning dashboard created specifically to highlight unrecognized patient deterioration, allowing clinicians to rapidly respond to maternity patients at risk.

What’s not so obvious is how PeriGen software helps with #3 and #10.

  • PeriGen’s cues and notifications are designed to make it as easy as possible to know when a patient needs attention.  The color-coding, combined with the option of sound, mean that the warning amplifies and focuses clinical attention on the areas of the strip and protocol parameters that are of the greatest concern at a moment in time.  Trend analysis, additionally, brings a bigger picture view of small, individual points of data showing clinicians what’s significant…and what’s not.
  • Today’s clinicians are awash in not only data and documentation, but in training programs.  These are essential of course to improving safety and quality, but the sheer volume of training information makes “safety net” technology like PeriGen’s software crucial for turning training into actual behavior.
  • Automating processes that have proven to improve patient safety and prevent negative outcomes is an important strategy for standardization of care.  Manual processes, especially when there are so many of them, are prone to breakage and change over time.  Automation, such as that offered by PeriGen’s CheckList tool, also has the added benefit of easing the weight of manual tasks bedside clinicians are faced with.

We encourage you to take a look at the ECRI Institute’s list of Top 10 Patient Safety Concerns for Healthcare Organizations.  The preview and Executive Brief are provided free once you register.


07 Mar

Change of instructor

Free Continuing Education

Register for the last few spots for

tomorrow’s free CE webinar

There are still a couple of spots open for tomorrow’s free online continuing education session covering uterine activity management.

Unfortunately, Rebecca Cypher, MSN, PNNP, PeriGen’s Chief Nursing Officer, originally scheduled to present tomorrow’s CE webinar, will not be able to make it.  Michelle Flowers R, an AWHONN-certified continuing education instructor, will be leading the session instead supported by Dr. Emily Hamilton, PeriGen’s Senior Vice President of Clinical Research.  They will be covering the nomenclature and definitions related to uterine activity, the etiology of uterine tachysystole (UT) and UT’s impact on FHR.

Registration is required.  Click here

28 Feb

Recently Published

PeriNews, PeriGen's take on what matters in obstetricsPeriGen assists Medstar in improving key labor & delivery outcome indicators

Becker’s Hospital Review, a health system management publication, recently published the results of a study done by Sam Smith, MD and Lynette Philips RN of Medstar as well as a team of PeriGen clinical researchers that highlights the impact of process improvement on obstetric outcomes.

The study examined ten years of data on 78,459 births at Medstar, a health system serving Maryland. Data on cesarean rates, NICU transfers, and the use of fetal resuscitation was examined before and after the introduction of a large-scale process improvement program that included the introduction of PeriGen’s decision support software tools.

Medstar results show decline in NICU transfers, fetal resuscitationKey results included:

  • A 54% reduction in the use of cardiopulmonary resuscitation, assisted ventilation, or intubation.
  • NICU transfers which had risen steadily prior to the program declined by 52%.
  • Cesarean rates stabilized after the introduction of the software despite continuously rising rates of obesity, diabetes and hypertension.

Read more


Samuel Smith MD, Lynette Philip RN, Adi Zmiri MD, Emily Hamilton MD, Thomas Garite MD. HIT and clinical synergy: A decade of decreasing NICU admissions & stabilizing cesarean rates, Becker’s Hospital Review, 2016 Dec 20.

27 Feb


PeriNews, PeriGen's take on what matters in obstetrics
The “cat’s whiskers” behind a

key concept of obstetrical safety

by Emily Hamilton, MD CM

No, we have not taken to caring for cats or declining Latin verbs. Yes, we are “over the top” on the concepts behind these acronyms and their contributions to obstetrical safety. MEWS1,MEWT2, MEOWS3 refer to examples of Maternal Early Warning Systems that operate in addition to usual clinical care. They have been proposed to facilitate timely recognition, diagnosis and treatment of patients developing critical illness. This assistance is relevant today because delayed recognition and intervention remain contributory factors in about half of births with maternal deaths or neonatal encephalopathy.4, 5

MEWS, MEWT and MEOWS are scoring systems based on a short checklist of key criteria, Maternal Early Warning Systemprimarily vital signs. Some variants add factors such as persistence, level of consciousness, urine output, lab tests or fetal condition. Some use color coding or weighting for different levels of abnormality. Important characteristics of successful warning systems are:

  1. Assessments are routine and repeated periodically, e.g. on admission and at frequent intervals
  2. Specific scores are tied to specific actions e.g. physician assessment, calling a rapid response team or initiating a specific investigation or therapy.

In obstetrics, early warning scores on ICU admission were strongly related to maternal mortality.6 A large “Before and After” study in the US found very significant reductions in severe maternal morbidity in the group where an early warning system was implemented and no changes in these rates in the control group without a warning system.7 A survey of 130 maternity units in 2013 in the UK indicated that 100% had implemented a formal early warning system, up from 19% in 2007.8

We are still learning the impact of Early Warning Systems in obstetrics and how to optimize them to improve efficiency. Nursing effort and alarm fatigue are important considerations.

But wait…. software could reduce that nursing effort by using information already recorded in the electronic medical record. In addition it could track how often and how early a particular trigger appears. We could use statistical techniques to determine exactly what clusters of parameters are most useful.

Stay tuned … the best is yet to come. Look for more information on this topic later this year.

1 Mhyre JM, DʼOria R, Hameed AB, Lappen JR, Holley SL, Hunter SK, Jones RL, King JC, DʼAlton ME. The maternal early warning criteria: a proposal from the national partnership for maternal safety. Obstet Gynecol. 2014 Oct;124(4):782-6.

2 Hedriana HL, Wiesner S, Downs BG, Pelletreau B, Shields LE.
Baseline assessment of a hospital-specific early warning trigger system for reducing maternal morbidity. Int J Gynaecol Obstet. 2016 Mar;132(3):337-41.

3 Singh S , McGlennan A, England A, Simons R. A validation study of the CEMACH recommended modified early obstetric warning system (MEOWS). Anaesthesia. 2012 Jan;67(1):12-8.

4 Main EK, McCain CL, Morton CH, Holtby S, Lawton ES. Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities. Obstet Gynecol. 2015 Apr;125(4):938-47.

5 Sadler LC, Farquhar CM, Masson VL, Battin MR. Contributory factors and potentially avoidable neonatal encephalopathy associated with perinatal asphyxia. Am J Obstet Gynecol. 2016 Jun;214(6):747.e1-8.

6 Carle C, Alexander P, Columb M, Johal J. Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database. Anaesthesia. 2013 Apr;68(4):354-67.

7 Shields LE, Wiesner S, Klein C, Pelletreau B, Hedriana HL. Use of Maternal Early Warning Trigger tool reduces maternal morbidity. Am J Obstet Gynecol. 2016 Apr;214(4):527.e1-6.

8 Isaacs, RA, Wee MYK, Bick DE, et al. (2015) A national survey of obstetric early warning surveys in the United Kingdom: five years on. Anaesthesia2014;69:687-9

24 Feb

The promise of spring

A new, more powerful

fetal surveillance system

Last year, when we announced that PeriGen and WatchChild had joined forces you may have noticed a promise. We indicated that we would be working to bring together the strengths inherent in each system to provide an even more powerful set of fetal surveillance solutions.

That promise wasn’t an empty one. This spring we will introduce you to an array of modules designed to incorporate the best of both PeriCALM and WatchChild. A system that incorporates your suggestions and ideas for solving your biggest clinical, integration, and technical challenges.

We can’t wait and we hope you’ll stay tuned for the big announcement this spring. In the meantime, don’t hesitate to contact your PeriGen Client Executive or visit the PeriGen website for ongoing updates.

24 Feb

Coming soon! PeriGen’s EFM Scholarship Program

PeriNews, PeriGen's take on what matters in obstetrics

One small contribution to

helping clinicians get better

and make more

PeriGen has announced the introduction of a continuing education program for labor & delivery clinicians that includes funding to cover the cost of taking the EFM credentialing exam through The Perinatal Quality Foundation (PQF).

Applications for the program will be available at the AWHONN National Conference in New Orleans and, after the event, on PeriGen’s website.

EFM credentialing is viewed by many labor & delivery professionals as one of the key components of effective obstetric patient safety programs. The PQF exam, developed by both physicians and nurses recognized as EFM experts, tests for knowledge and judgment. The exam is available online and preparation – one of the objectives of PeriGen’s free continuing education modules – is considered key to passing.

For more information on the PQF credentialing exam, click here to access an article in Contemporary OB/GYN or visit the Perinatal Quality Foundation’s website.

24 Feb

An appetite for change & cheesecake

PeriNews, PeriGen's take on what matters in obstetrics
An introduction leads to some important

reminders about standardization

by Matthew Sappern, CEO

A new acquaintance recently reintroduced to me an article authored by Dr. Atul Gawande that piqued my appetite for change – and cheesecake!How healthcare standardization is like the art of making good cheesecake

In “Big Med,” published in the August 13, 2012 issue of The New Yorker Gawande touched on one of my favorite topics – standardization. His lightning bolt came while dining at The Cheesecake Factory. His guests ordered a wide variety of dishes from a seemingly endless menu – the food was uniformly presented and immensely satisfying. So, he went back in to the kitchen and learned how The Cheesecake Factory has struck an effective balance between universally applied standards and the tacit knowledge of the chefs, which I liken to “freedom at the grill.”

Today’s growing “super-regional” health systems are moving to PeriGen because they need to find ways to ensure this balance for the sake of quality care.

It is virtually impossible to ensure consistency in how individual L&D nurses across a health system will assess potentially disturbing trends; that lack of consistency will always limit the efficacy of even the most well-considered protocols. Alternatively, computer systems designed, trained and deployed to vigilantly identify specific patterns that might be of concern lends some control to the effort. The quest for continuous improvement relies on standardization for the baseline. Once potential issues are consistently identified – the clinicians can consider each case. In other words, they can achieve freedom at the grill.