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

Reference:

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 Sep

My Post-Summer Research Reading List

In The myths and physiology surrounding intrapartum decelerations: the critical role of the peripheral chemoreflex published in the Journal of Physiology, Lear et al have written a highly readable and methodical analysis of current evidence about the mechanisms of fetal heart rate decelerations. This is a must read for anyone seriously using fetal monitoring. He challenges long held tenets and presents a simplified coherent approach to the interpretation of heart rate monitoring. Here are two excerpts that may compel you to read further:

“… Despite multiple detailed analyses, there is no consistent FHR marker of fetal compromise …”

“… We believe that it is better to focus on the frequency, depth and total duration of decelerations during labor rather than on timing, shape or supposed aetiology of the specific deceleration.”

In an article published recently in the American Journal of Obstetrics & Gynecology titled Triggers, bundles, protocols, and checklists — what every maternal care provider needs to know, Arora et al define and provide examples of various methods to standardize and streamline clinical care and summarize the evidence supporting their association with improved outcomes. Many examples are provided for obstetrical issues such as hemorrhage, hypertension, oxytocin usage or preop preparation. With burgeoning evidence from diverse medical and non-medical domains, the question is no longer “Do these methods work?“, but rather “How can we get wider adoption and sustain compliance?” In short, how do we actually change established clinical beliefs and behaviors? This article is less informative on these practical issues.

InfluencerThere is abundant data about effective ways to change behavior. In short, behaviors will not change without aligning a critical mass of influential factors. Determination and good intentions alone are insufficient and depending upon them alone is destined to fail. To supplement this review of available obstetrical safety packages we strongly recommend the book- Influencer: The New Science of Leading Change, Second Edition by David Maxfield, Ron McMillan, Al Switzler. (Click here to see a summary of this excellent work)

10 Dec

An improved labor curve tool

Last week’s webinar, covering research on a new method to assess labor progress, continues to stimulate comment and debate. The session described a whole new labor curve concept, one that adapts to the multiple factors affect dilation directly and change as labor advances. Recent peer reviewed publications report a five-fold improvement in the rate of identification of first time mothers who actually underwent a cesarean for slow labor using the PeriCALM Curve compared to the rate using the current fixed labor curves that are based on time only (70% vs 12%).

The research, outlined in two articles recently published in the American Journal of Obstetrics & Gynecology, was reviewed by Dr. Emily Hamilton during a lunchtime session offered by PeriGen. The session, titled “Rethinking the Labor Curve,” was recorded and can be viewed here.

Dr. Hamilton led the research team that applied a modern, mathematical approach to the assessment of labor. The team found that the utility of contemporary labor curves was limited because of, among other things, a wide degree of variation in the early stages of labor. In fact, it is not until late labor when dilation reaches six centimeters that this variation enters useful limits and the contemporary curves can be used. The new approach can be applied earlier to assess two essential processes for vaginal birth (dilatation and descent). Results are expressed with percentiles and graphs.

The video, access to the basic research, and the slides are available by clicking here.

We look forward to hearing your thoughts and questions too.

07 Oct

The PeriGen Journey

PeriGen featured in One Million by One Million Blog

The PeriGen Journey

During last week’s interview with Sramana Mitra,  the founder of One Million by One Million, Emily Hamilton outlined the long, often winding journey taken from her seed research into labor progress at McGill University to the forming of PeriGen to today’s fast growth as more and more hospitals realize the patient safety benefits of applying advanced technology to labor & delivery patient care.

She detailed how McGill’s mission of enabling world-class expertise and her love of “tinkering” led to government funding for the collaboration of a group of mathematicians, engineers, and clinicians that developed a totally new method — a mathematical model — for measuring labor progress, one designed to assess whether progress is normal or significantly abnormal to require intervention.

Emily describes how the new product was tested in her own backyard in Canada where almost all Montreal hospitals tested and then rolled out the prototype.  The hard part came with the attempt to extend reach into the Unites States.

“It certainly was harder when I stepped outside of my backyard.  With novel ideas, there’s a fair bit of skepticism as well.  Obstetrics has a lot of medico-legal pressures so there’s a lot of fear of doing anything that’s new,” explains Emily.

Enter PeriGen

Joining Emily Hamilton during the One Million by One Million interview, Matthew Sappern (PeriGen’s CEO) explained the next leg of the journey.

“PeriGen is actually the combination of a company called E&C Medical, originally based in Tel Aviv, and LMS, Emily’s company in Canada.  E&C was trying to do pretty much what Emily’s team was rolling out.    The companies were brought together under the name PeriGen to offer their compelling technologies within the US market,” says Matthew.

The combination has proved to be a powerful one.  Under Matt’s leadership, PeriGen has gained avid evangelists for their technology among the obstetric and investing communities.  The result has been significant growth and a remarkable level of traction, especially in the last 18 months.

Click to read the entire interview on One Million by One Million