OB Critical Care Partnership Model

Morbidity and mortality of pregnant and postpartum women is increasing in the United States (U.S.) at an alarming rate. The rate of severe complications in pregnancy has doubled in the last decade, and near misses have increased. Maternal mortality review committees report that up to 50% of maternal deaths in the United States are preventable. For these reasons, it is essential to provide specialized services dedicated to critical obstetric illness for pregnant and postpartum women to ensure optimal outcomes. While the optimal setting for the provision of critical care for obstetric women has not been identified, a collaborative interprofessional partnership model for obstetric (OB) critical care services that was designed and implemented in a Level IV perinatal and quaternary care hospital will be described. The goal of the OB critical care program was to create an interprofessional collaborative approach to ensure excellent patient care and outcomes, bringing complex essential nursing and medical expertise to the patient. Transfer criteria for OB critical care will be described, including a system for transfers to ease point of entry, a care model, a collaborative education plan, and other key elements of an evolving program.

The aspects of critical care specific to pregnancy and postpartum are varied and demand that care providers have a thorough knowledge of maternal changes in physiology, fetal considerations, and an awareness of specific concerns in the postpartum period. Education sessions including simulation were created in phases for the interdisciplinary team building on previous content. Staff nurse champions were identified and sent to specialized education to develop them as resources for the program to assist with ongoing education and program development. Women are cared for in the intensive care unit (ICU) by an ICU RN, and an OB RN. This includes shared bedside shift report, participation in multidisciplinary rounds, and coordination of the consultants, equipment, and supplies that may be needed. Resources were developed for quick reference on OB specific medications, algorithms outlining program processes, and cardiopulmonary resuscitation in pregnancy including perimortem cesarean. The projected daily census is 1-2 patients per day at our facility that may not previously have benefitted from this model of care. Preventable, sometimes tragic maternal and fetal complications can be avoided with early identification and transfer of the critically ill pregnant or postpartum woman to a center prepared to provide OB critical care. This multidisciplinary approach and model, designed to achieve optimal outcomes can be replicated by other health care facilities.