Oct. 08, 2021
Mayo Clinic Obstetrics in Rochester, Minnesota, is undertaking a large public health project: offering small emergency departments and hospitals 24/7 virtual access to obstetricians (OBs) to help stabilize expectant mothers with acute conditions. A National Institutes of Health grant funds the project.
Given the current shortage of practicing OBs nationwide and a rural obstetrics exodus, many communities don't have day-and-night specialty care for pregnant women requiring urgent assistance. Even if an OB is on staff at a small remote hospital, that physician may take calls from home, rather than being continuously on-site for emergent situations.
Since fewer OBs are around at all times for emergencies, women in rural settings are now farther from appropriate specialty care, which affects outcomes.
"The rural OB exit has contributed to increasing U.S. morbidity and mortality," says Regan N. Theiler, M.D., Ph.D., chair of Obstetrics at Mayo Clinic's campus in Rochester, Minnesota, and program leader.
Dr. Theiler says factors beyond medical care access that affect maternal morbidity and mortality include the aging maternal population, the opioid epidemic, morbid obesity and other comorbidities.
She says specific conditions significantly impacting morbidity and mortality in pregnant women nationwide today include:
- Severe hypertension
Treating an expectant mother in an acute situation requires managing her condition, remaining cognizant of the pregnancy to ensure maternal and fetal survival, and reducing complications.
"The interesting thing with all these conditions is that they're treated differently in pregnant women," Dr. Theiler says. "In emergencies, these issues usually are reparable by nonsurgical means."
The acute teleOB program
Dr. Theiler's team wants to help reduce morbidity and mortality and bridge the gap for non-OB medical professionals needing immediate help caring for pregnant mothers in acute situations. Thus, the team developed a program offering small emergency departments and hospitals virtual Mayo Clinic OB specialist access round-the-clock. The aim of the service is to improve care quality and help medical centers achieve the standard of care for serious events in pregnant patients, including severe hypertension treatment within 30 minutes.
"They can just turn on the video and have access to Mayo Clinic laborists," says Dr. Theiler. "We're here and awake 24/7 if the primary people who see acute OB cases in your facility or the backup for them is not immediately available. Even our backup for the Mayo obstetricians who do virtual consults is already in the hospital and accessible."
Dr. Theiler says providers in small rural emergency departments may not be planning on providing OB care. Yet an expectant patient may enter the facility at any time presenting with an urgent medical issue.
"These kinds of situations are rare for a facility like this, and they take specialty knowledge," says Dr. Theiler. "For instance, an emergency department provider in a rural facility may recognize a serious OB condition, but we can help by telling them what it is and how to treat it. When you need this consult, you really need it. We think we can be a resource to small hospitals in more-remote U.S. locations."
Mayo Clinic OB staff train participating facilities' acute care personnel. This training includes practice accessing the Mayo consult service and a review of emergency maternal care, such as simulated scenarios and advice on products to store. Network members may contact the Mayo service at any time for advice or to walk through an encounter in which an expectant mother requires immediate intervention. The consulting Mayo OB can also assist in calling an air ambulance or obtaining appropriate blood products. After a virtual consult, the Mayo OB writes up a consultation report for the midwife, primary care doctor or OB regularly following the patient.
Mayo Clinic opened the acute care teleOB program before COVID-19. The pandemic, however, brought telemedicine to the fore and improved its status, reinforcing the Mayo program.
To practice outside Minnesota, even virtually by telemedicine, Mayo Clinic OBs involved in the project need credentials in multiple states. Currently, they're licensed in Minnesota and Wisconsin and provide consultation to Mayo Clinic Health System facilities. They began preparing for multiple licensures before COVID-19 affected the U.S., but the pandemic has accelerated this project's pace.
This service also comes with data mart access, a Mayo Clinic project to collate validated data for quality improvement and monitoring across all Mayo hospitals.
"When you measure outcomes that are rare events, you need huge data sets to make meaningful conclusions," says Dr. Theiler.
The network: How your facility may participate
The Mayo Clinic acute care teleOB program wants to add sites to its network and is open to exploring potential participating facilities throughout the U.S., says Dr. Theiler. She and colleagues currently are in discussions with external hospitals about joining the program. Teleneonatology services also are available.
The program requires the following technology to ensure quality 24/7 acute teleOB coverage:
- Stable, high-speed internet connection in all facility rooms
- Robots, tablets or other connected devices
"This is a service to providers working in the field, bringing help and peace of mind," says Dr. Theiler. "We're expanding our efforts to serve underserved areas of the country, particularly rural areas where women don't have 24/7 access to maternal care. This is the opposite of the destination medicine concept — it's bringing specialty medicine to the patient."
Interested medical centers may contact Dr. Theiler at firstname.lastname@example.org.
For more information
Teleneonatology Program. Mayo Clinic.