Hospital aims for best births
Obstetrical unit focuses on teamwork, less intervention as part of MORE OB program
Casey Lessard
Northern News Services
Monday, May 25, 2015
IQALUIT
From womb to home, every mother wants her child to have a smooth transition.
Supported by Qikiqtani General Hospital chief of staff Dr. Sandy MacDonald, at left, Dr. Patty DeMaio shared an update about the success of MORE OB, which stands for Managing Obstetrical Risk Efficiently, May 20. The program has helped improve birthing outcomes at the hospital, where they were already among the best in North America.- Casey Lessard/NNSL photo |
So it will be comforting to Nunavut women that Qikiqtani General Hospital is investing in improving already excellent outcomes in the hospital's maternity ward, where more than 400 babies enter the world annually.
The Iqaluit hospital is now entering its third year participating in MORE OB - Managing Obstetrical Risk Efficiently - an international program to improve teamwork and communication for the benefit of mothers and babies.
"Our excellent outcome indicators tell us that we're doing a good job," said, Dr. Patty DeMaio who leads the obstetrics team. "Our intervention rates in obstetrics labour and delivery are very low. We consistently have amongst, if not the lowest, caesarian-section rates in North America."
Qikiqtani is an outlier among Canadian hospitals, with a caesarian-section rate about one-fourth the national average. Why is that important? A C-section, like any operation, involves risks. They include infection at the wound site, blood clotting, and complications in future pregnancies and births. One advantage of a C-section is you know your delivery date and can avoid the pain of a vaginal birth.
But it's still an operation, and with no obstetrician on-site in Iqaluit, the doctors prefer to avoid the risk.
"It shapes our approach differently than a specialty where you're trained to do interventions," DeMaio said. "It's not the culture here. We tend to let labour progress as naturally as possible, and tend to have a hands-off approach, meaning we try not to medicalize birth as much as we can. We try to make sure women are safely cared for and are watching and thinking ahead of things that may go wrong, but we don't medicalize what we don't need to medicalize."
Qikiqtani General adopted MORE OB in April 2013, with staff spending the first year getting on the same page in terms of evidence-based information about obstetrical risk. The focus is on patient safety and professional development.
It can be a challenge to keep a rotating staff of doctors and nurses on the same page, so MORE OB is helping the staff improve communication and teamwork, DeMaio said.
"We have weekly team rounds every Thursday," she said.
"And it involves telehealth video connection with several communities and the nurses in those communities sit down with their obstetrical patient cases and we review them with them."
In the second year, the team performed audits and patient surveys to determine how the department was doing. Patient satisfaction rates are consistently high, she said, and the low C-section rate is a point of pride.
This year, the team will focus on areas of patient risk and how to address them as an institution.
"We certainly see it as a model we would hope to adapt to other areas of the hospital," said chief of staff Dr. Sandy MacDonald.
"The key to it that is transferable is the concept of teamwork. In an obvious way, people work as a team in the emergency department, but in the medical world, we haven't thought of ourselves in a teamwork way as much as the MORE OB emphasizes. We certainly see this spreading in other areas of the hospital and health care."
Although the program wraps next spring, DeMaio sees the value of continuing to subscribe to the model and update learning materials annually.
"This is something all institutions should be doing in all areas of care rather than being reactive," she said. "There's always areas you can be proactive."
