21 Dec

Why EFM trends are important

The importance of longer EFM views

Inventor of PeriGen advanced fetal monitoringby Emily Hamilton, MD CM
Senior Vice President, Clinical Research

Labor and delivery clinicians use EFM to identify fetal intolerance to labor to guide intervention and prevent hypoxic fetal injury. This task requires not only assessing the past and current degree of tracing abnormality and but projecting what is likely to happen in the near future. There is good evidence that tracing abnormalities generally evolve over hours (1-3). In addition, intervention guidelines usually recommend evaluating fetal response to supportive interventions over 30 to 60 minutes before resorting to cesarean delivery (4, 5). Thus long term assessments are essential. Standard computerized displays provide views of only 8 -10 minutes of tracing. Short term “snapshot” views can contribute to a failure to appreciate duration of tracing abnormality and the likely evolution.

PeriCALM Checklist analyzes EFM tracings in a consistent fashion. Its displays show long term trends over several hours, color coding regions of abnormality according to the criteria set by the institution. Such displays help clinicians see if a problem is intermittent or persistent, improving or deteriorating, stable or changing rapidly. A view of EFM trends may assist with situational awareness and helps clinicians in acute care settings more accurately project what is likely to happen and institute appropriate care. Checklist techniques and methods are especially pertinent in acute care settings during night time work when large amounts of data must be processed by the care givers over many hours. (6,7)

1. Vintzileos AM, Smulian JC. Decelerations, tachycardia, and decreased variability: have we overlooked the significance of longitudinal fetal heart rate changes for detecting intrapartum fetal hypoxia? Am J Obstet Gynecol. 2016 Sep;215(3):261-4.
2. Elliott C, Warrick PA, Graham E, Hamilton EF. Graded classification of fetal heart rate tracings: association with neonatal metabolic acidosis and neurologic morbidity. Am J Obstet Gynecol. 2010 Mar;202(3):258.
3. Clark SL, Hamilton EF, Garite TJ, Timmins A, Warrick PA, Smith S. The limits of electronic fetal heart rate monitoring in the prevention of neonatal metabolic acidemia. Am J Obstet Gynecol. 2016 Oct 14. pii: S0002-9378(16)30872-9. doi: 10.1016/j.ajog.2016.10.009. [Epub ahead of print]
4. Clark SL, Nageotte MP, Garite TJ, Freeman RK, Miller DA, Simpson KR, Belfort MA, Dildy GA, Parer JT, Berkowitz RL, D’Alton M, Rouse DJ, Gilstrap LC, Vintzileos AM, van Dorsten JP, Boehm FH, Miller LA, Hankins GD. Intrapartum management of category II fetal heart rate tracings: towards standardization of care. Am J Obstet Gynecol. 2013 Aug;209(2):89-97.
5. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol. 2009 Jul;114(1):192-202.
6. Chapter 46. Fatigue, Sleepiness, and Medical Errors. AHRQ. (accessed December 2, 2016) https://archive.ahrq.gov/clinic/ptsafety/chap46a.htm
7. Fioratou E, Flin R, Glavin R, Patey R. Beyond monitoring: distributed situation awareness in anaesthesia. Br J Anaesth. 2010;105:83-90.

20 Dec

How one health system used HIT to control rate of Cesareans


Cesareans stabilized, NICU admissions and resuscitation decline after implementation of PeriCALM® Patterns™

Becker’s Hospital Review just released the results of 10-year study on the impact of process improvement and the use of PeriCALM on the rate of cesareans, NICU admissions and CPR/ventillation/intubation.

The study, authored by Sam Smith MD and Lynette Philip RN of MedStar and Adi Zmiri MD, Emily Hamilton MD CM, and Thomas Garite MD of PeriGen, looked at data for 78,459 births for Cesarean rates, NICU admissions, and the use of extraordinary fetal resuscitation procedures before and after the introduction of a management focus on care processes and staff training combined with the use of PeriCALM Patterns.

Following is a summary of the results published by Becker’s:

  • Despite an increase in factors associated with rates of cesarean sections, the rate of cesareans remained stable after the introduction of PeriCALM and advanced management strategies.
  • NICU admissions declined by more than half after PeriCALM and the process improvement steps were introduced.
  • The number of babies requiring unusual resuscitation measures in the delivery room decreased from 5.2% to 2.4%.

Click to access the Becker’s article providing full results and details

13 Dec

Build-a-Bike Challenge Trivia Quiz

A few of the trivia questions asked

during last week’s PeriGen team-building event

Here are a few of the questions we asked the PeriGen team as part of last week’s ‘Build-a-Bike Challenge.’  Teams that answered them correctly were awarded a point each and received a part of the bike they were building.

To see the answers, simply click on the questions. And, please, let us know how you do!

  • What is a DAS?
  • At what university was Patterns originally invented?
  • In what state is it illegal to kill mice without a hunting license?
  • Emily Hamilton's recent analysis of birth data indicates that cesarean rates did what since PeriCALM Patterns was installed at MedStar 10 years ago?
  • What is an example of a standard interface?
  • What were the wheels of the smallest adult bicycle made of?
  • Covered California, the state's health insurance program, indicates that they will remove hospitals based on what childbirth metric?
  • For WatchChild, what does BAM stand for?
  • In what city was Patterns first tested in a hospital?
  • Name the world's largest ocean.
  • What is the WatchChild database storage requirement?
  • What chess pieces can only move diagonally?
  • What WatchChild solution allows caregivers to monitor patients at any network-enabled location within the hospital (e.g., ED/ICU) and external locations such as physician offices?
  • How did the 17th president of the US, Andrew Johnson, start his career in Raleigh, NC ?
  • Which PeriGen client often provides Emily Hamilton with historic birth data (depersonalized) for clinical data analysis?
  • Name an EMR with which both WatchChild and PeriCALM can integrate?
  • According to a recent AJOG article co-authored by Emily Hamilton, when are ACOG first stage arrest criteria most applicable?
A store and forward device
McGill University
Ohio
Cesarean rates stayed the same despite an increase in risk factors associated with cesareans
ADT, LAB, pharmacy, outbound vitals/annotations
Silver dollars
The annual percentage of cesarean sections
Baby and Mother
Montreal
The Pacific
10MB per patient per day (uncompressed)
Bishops
Mobile Fetal Monitoring
He was a tailor’s apprentice
MedStar
Epic, Meditech, Allscripts, Cerner
After dilation has reached 6 CM
12 Dec

This PeriGen event starts like any other, but…

Bruno Bendavid, SVP of Product Management and Brian Bishop, Chief Product Manager update the operations team on current road map items

Bruno Bendavid, SVP of Product Management, and Brian Bishop, Chief Product Officer, hold a product roadmap briefing session

This week, the PeriGen North America team met to collaborate, map the future, and socialize in our new hometown,  Cary, NC. The event, including both PeriCALM and WatchChild team members, started as you would expect.

Denise Queffelec congratulates Allan Kyburz on his latest family addition

Denise Queffelec, SVP of Operations, congratulates Allan Kyburz, Client Executive, on his newest family addition

 

 

 

Lots of introductions and matching faces to the names made familiar through phone and email.  Lots of handshakes and hugs.  Lots of questions asked and answered over shared meals.

With the joining of PeriGen and WatchChild, purchased from Hill-Rom 10 weeks ago, the work to learn from each organization and meld them into a dynamic whole started from the get-go.  This week’s event focused on expanding initial learning, cross-training, and developing an improved, expanded customer support team to provide an even deeper, more convenient customer experience.

Matthew Sappern, CEO, opens up 'The PeriGen Build-a-Bike Challenge'

Matt Sappern, PeriGen’s CEO, launches the ‘Build-a-Bike Challenge’

And then the time for team building began.

Chip Long, PeriGen’s senior vice president of sales & growth, had arranged for a special surprise: PeriGen’s first ‘Build-a-Bike Challenge.’

 

 

Amidst the hard work and laughter, the team got together last Thursday afternoon to hold a trivia contest and build ten bikes for ten very special “Littles” from Cary’s Big Brothers, Big Sisters organization.

Team #2 shows off the bike they built for Big Brother, Big Sister "Little" KanYa

Team #2 shows off the bike they built for Big Brothers, Big Sisters ‘Little’ KanYa

The challenge featured teams of four-five with six rounds of pretty tough trivia questions.  Topics ranged from childbirth, technology, WatchChild, and PeriCALM to turkeys, geography, hunting licenses, and more. (Click here to take a stab at answering them yourself.)

 

 

 

Team #4 was one of the first to complete the bike they build for Nakayla

Team #4 was one of the first to complete the bike they build for Nakayla

 

Every correct answer resulted in one point for the team and the one part of their bike.  At the end of the trivia challenge, each team started to build their bike.  Although no prizes were awarded for the speed in which the bikes were built, you can guess that the rivalry continued!

 

PeriGen Build-a-Bike Challenge Team #9 named themselves 'The Heart Throbs'

PeriGen’s ‘Build-a-Bike Challenge’ Team #9 named themselves ‘The Heart Throbs’

 

 

First, second, and third place prizes went to the teams with the highest trivia performance scores, but the real reward came as a complete surprise to everyone when …

 

 

 

 

Kids from Big Brothers, Big Sisters in Cary NC joined PeriGen to receive bikes built during the "Build-a-Bike Challenge"

“Littles” from Cary’s Big Brothers, Big Sisters organization join PeriGen to receive their “Build-a-Bike” holiday gifts

 

… after building their bikes and basking in the glow of jobs well done, there came a soft knock on one of the doors and…

PeriGen was joined by “Littles” from Big Brothers, Big Sisters in Cary, NC who each received a bike built during the “Build-a-Bike Challenge.”

 

 

 

PeriGen was proud to support the local Big Brothers, Big Sisters organization

One of the “Littles” from the local Big Brothers, Big Sisters organization receives a bike built by PeriGen during the ‘Build-a-Bike Challenge in Cary last week

 

 

The reaction was immensely heart warming for the PeriGen teams and, we think, a special event for the kids.

 

 

 

 

 

"Littles" from Cary's Big Brothers, Big Sisters organization enjoyed riding their new bikes around the conference room

What a blast it was watching the “Littles” take their bikes for test drives during the ‘Build-a-Bike Challenge’ last week

06 Dec

PeriCALM CheckList nominated for Edison Award

CheckList nominated for 2017 Edison Award for innovation

Protocol Management Tool again

recognized for innovation,

nominated for Edison Award

PeriGen announced today that their protocol management tool, PeriCALM CheckList, has been nominated for a 2017 Edison Award.  The Edison Awards recognize and honor innovation and innovators who make a positive impact in the world.

CheckList also received a Fierce Health Innovation Award earlier this year.

The Edison Awards are named after Thomas Alva Edison (1847-1931) who developed 1,093 patented new products, including the incandescent electric light and the system we still use today to generate electrical power.  His other products include the telephone transmitter, the phonograph, the first storage battery, and a motion-picture camera.

Edison Awards nominees are evaluated not only on their impact, but also the method of conceptualization, product value (advantages and differentiation), and marketing delivery.

PeriCALM CheckList, a module of the PeriCALM electronic fetal monitoring and analytics software solution, is designed to help bedside perinatal clinicians identify when patient EFM metrics match specific protocol parameters.  Although it is highly customizable, it is most often used by hospital clients to monitor oxytocin protocols.  The automation of protocol management that CheckList offers aims to save labor & delivery providers time by eliminating manual calculations and improve data accuracy.  Published research on obstetric protocols, in addition, have been shown to improve outcomes and lower cesarean section rates.

The module also includes a unique export feature, saving additional time by sending EFM data to the EHR and to annotations after review.

 

14 Nov

Pratt Regional adds PeriCALM for Patient Safety

PeriCALM Goes Live at Pratt Regional

The PeriCALM launch team for Pratt Regional Medical Center includes Joanne Fullerton, Trent Green and Lisa Steele of PeriGen, as well as Stephanie Simmons and Amanda Vandervoort of Pratt Regional

Pratt Regional Medical Center, serving Pratt, KS, went live this week on PeriCALM.  They’ve added the Patterns patient safety tool, as well as the PeriCALM fetal surveillance tool.  The installation includes an ADT interface and Coldfeed.

Pratt Regional Medical Center is a progressive provider serving south central Kansas and the pan-handle of Oklahoma.

11 Nov

PeriGen rolls out SSO with Epic across Legacy

Legacy Good Samaritan Medical Center in Portland, OR

Legacy Health adds PeriCALM Single Sign On with Epic to help its Labor & Delivery Teams

Good news!  PeriGen is making life a bit easier for the labor & delivery teams of Legacy Health locations with single sign-on.  All five of Legacy’s locations rolled out PeriCALM’s single sign-on with Epic this week.

Legacy Health is a leading non-profit health system serving Oregon.  Headquartered in Portland, the Legacy Health system includes seven hospitals and more than 50 clinic locations, plus research, hospice and lab services.

Legacy Health uses all components of the PeriCALM system as part of their fetal surveillance and patient safety toolkit.

10 Nov

Impact of the laborist model on obstetric care

Research Summary:
Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes*

Inventor of PeriGen advanced fetal monitoringBy Emily Hamilton, MD CM, Senior Vice President of Clinical Research

This study, published in the August 13th issue of the American Journal of Obstetrics & Gynecology, examines outcomes before and after the introduction of a laborist model of care. Surprisingly, very few differences were noted when comparing changes over time in the hospitals with laborists to changes over the same period of time in the matched hospitals without laborists. This paper describes an interesting methodology to try and tease apart the effect of various factors on obstetrical outcomes. This is relevant because most quality improvement initiatives are studied in a before-and-after fashion and not in a prospective randomized trial.

The study is discharge summary data to NPIC between 1998 and 2011. Results from three hospitals where laborists were introduced were compared to six control hospitals matched for delivery volume, geographical area, teaching hospital status and level of neonatal nursery.

Once adjustment was made for several patient-related factors, no differences were observed in the odds ratio (OR) for any of the neonatal outcomes or for cesarean rates. The OR was reduced only for induction of labor (0.85 95%CI 0.71-0.99) and for Preterm Birth (0.83 95%CI 0.72-0.96). Although the OR for Preterm Birth was reduced this was not accompanied by a change in the OR for the birth of babies weighing

In short, the introduction of laborists was associated with a change in medical behavior (Induction of labor) and some change in actual outcome (preterm births), but not in low-birth-weight babies. A question that springs to mind immediately is the role of unmeasured factors such as policies to curtail elective induction of labor prior to 39 weeks that became common during this timeframe and were not adopted by all hospitals at the same time. Evidently the desire to improve is alive and well in many hospitals and there is no single solution for all.

Reference:
*Srinivas SK, Small DS, Macheras M, Hsu JY, Caldwell D, Lorch S. Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes. Am J Obstet Gynecol. 2016 Aug 13. https://www.ncbi.nlm.nih.gov/pubmed/27530491

09 Nov

How L&D Teams Use Protocols

What do you think? Is that a late?It’s hard to believe it’s been nine years, almost ten, since Steven Clark et al published “Implementation of a conservative checklist-based protocol for oxytocin administration: maternal and newborn outcomes.” Their study found that the use of a checklist-based protocol for oxytocin administration could reduce maximum infusion rates without lengthening labor or increasing operative intervention. In fact, cesareans decreased as a result of the use of the protocol.

To understand how protocols are handled today, PeriGen has launched an ongoing research survey. So far, 129 clinicians have participated. Here is a summary of results so far:

  • 96.7% of respondents use protocols to improve patient safety
  • The top three most commonly used protocols are for obstetric hemorrhage (8.2%), induction/oxytocin (7.6%) and pre-eclampsia (6.8%).
  • Most protocols (56.06%) are managed via a combination of EHR forms, paper forms and separate electronic forms. Few (6.1%) are actually integrated with the EFM.
  • Despite published research indicating induction protocol compliance was 40%, the mean estimate for protocol compliance among respondents is 90%.
  • Most respondents (53.85%) indicate that their teams spend about 1-3 hours a month on training, including initial training, for the protocols they use.
  • Respondents (47.7%) also say they meet as needed to analyze and generate ideas about increasing the effectiveness of the protocols they use, although 21.5% schedule monthly meetings.

To view an infographic of the survey results, please click here. To participate, click here.

08 Nov

Recommended Reading: A Profile of Friedman

Recommended Reading A Profile of Emanuel A. Friedman*

Dr. Emanuel A. Friedman, father of the labor curveEvery practitioner and student of obstetrics owes much to the landmark works of Emmanuel A Friedman. Recently, Dr. Romero, Editor in Chief of the American Journal of Obstetrics and Gynecology, interviewed Dr. Friedman and has chronicled his remarkable story for us. As with many discoveries or inventions, Dr. Friedman’s creative journey was triggered by happenstance and adversity.

While we may debate the merits and shortcomings of the mathematical techniques available in that era, especially when compared with the mathematical methods available today, no one can question how Dr. Friedman raised the level of thinking about labor by a quantum leap. I treasure an autographed copy of his 1955 publication entitled Primigravid Labor; a graphicostatistical analysis.

I highly recommend Dr. Romero’s essay on one of our great obstetrical thinkers.

Reference:
*Romero R. A profile of Emanuel A. Friedman, MD, DMedSci. Am J Obstet Gynecol. 2016 Oct;215(4):413-4. doi: 10.1016/j.ajog.2016.07.034. Epub 2016 Aug 3.
http://www.ajog.org/article/S0002-9378(16)30469-0/abstract?cc=y=