Communication, High Risk Pregnancy, Multidisciplinary Communication, Obstetric Complication
Conditions
Keywords
obstetric anesthesia, telemedicine
Brief summary
In January 2017 investigators started a Center for Peripartum Optimization (CPO) with the aim of optimizing a patient's clinical status in an outpatient setting to minimize unnecessary laboratory tests and studies, costly inpatient consultations, the likelihood of post-surgical adverse events, escalations in level of care, inpatient admissions and readmissions. This research project seeks to evaluate the impact of this innovative concept on patient outcomes during the last 12 months. Investigators will accomplish this by collecting retrospective data from patients' electronic medical records in the intervention group and comparing it to data gathered from a controlled group of patients with similar comorbidities but who were not evaluated at the CPO clinic.
Interventions
OTHERSeen in clinic
We will be doing a retrospective chart review of patients seen in the Center for Peripartum Optimization to look for: 1. Primary outcome variable. \- Hospital length of stay 2. Secondary outcome variables. * Number of admissions from outside hospitals * Adverse outcomes * Intensive Care Unit admissions * Opioid use * NICU admissions * Patient satisfaction * Cost of inpatient admission * Cost of outpatient care * Hospital readmissions rate
Sponsors
Johns Hopkins University
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
No minimum to 60 Years
Healthy volunteers
No
Inclusion criteria
* Records of all female, obstetric patients of child-bearing age who were evaluated in the Center for Peripartum Optimization during the period between January 2017 and January 2018. * Controlled group will include parturients with match high risk comorbidities or history of nonobstetric surgery during pregnancy who delivered at Johns Hopkins Hospital (JHH) during July 1, 2016 - Dec 31, 2016 * Patients with any one or more of these high risk comorbidities: * Complex spine pathologies (Scoliosis, vertebral fusion, disc disease, spinal canal defects, neuropathies, and nerve disease, etc.) * Neurological pathology (Cerebral ischemia, tumor, increased intracranial pressure, cerebral vascular disease, etc.) * Cardiac disease (Congenital, valvular, pulmonary hypertension, cardiomyopathy, ischemic disease, arrhythmia, etc.) * Pulmonary disease (History of pulmonary embolism, interstitial lung disease, severe asthma, cancer, etc.) * Morbid Obesity (Obstructive Sleep Apnea, equipment considerations) * Hematologic Disorders (Thrombophilias, coagulopathies, patients on anticoagulation) * Cancer * Abnormal placentation (Previa, accreta / increta / percreta) * Anesthetic concerns (Airway abnormalities, history of adverse anesthetic reactions or experiences (i.e. recall, anaphylaxis)) * Fetal therapy patients requiring specialized management (Ex utero intrapartum treatment (EXIT), Fetoscopic endotracheal occlusion (FETO), Twin-to-twin transfusion syndrome (TTTS), Percutaneous Umbilical Blood Sampling (PUBS), etc.) * Chronic Pain
Exclusion criteria
* Records of CPO participating parturients outside the specified timeframe. * Records of obstetric patients of child-bearing age without high-risk comorbid conditions described in inclusion criteria. * Records of patients seen in CPO clinic that did not deliver at our institution
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hospital length of stay | 1 year | Total days of hospital admission |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ICU admissions | 1 year | Whether patient needed ICU admission or transfer |
| Opioids use | 1 year | To determine if patient require opioid use |
| Neonatal Intensive Care Unit (NICU) admissions | 1 year | Number of times a neonate got admitted to the NICU |
| Number of admissions from outside hospitals | 1 year | The total number of admissions to any other hospitals prior to admission or after discharge |
| Cost of inpatient admission | 1 year | the entire admission cost of admission during hospital stay |
| Cost of outpatient care | 1 year | The cost for outpatient care incurred by patient |
| Hospital readmissions rate | 1 year | The number of times a patient got readmitted after discharge |
| Patient satisfaction | 1 year | Whether patient was satisfied (yes/no) with treatment course based on survey filled out by patient. |
Countries
United States
Outcome results
None listed