Inside the labor-and-delivery department at HCA Healthcare, clinical teams monitor maternal and fetal status on a continuous basis, with overall safety as their North Star. It’s a big task for a hospital system that delivered 215,000 babies in 2020 — more than any other network of hospitals in the nation — and HCA Healthcare’s commitment to continually learning and improving maternal care as well as investing in advanced technologies and cutting-edge innovation has helped position it as a leader in this care area.

In labor-and-delivery units, it’s not uncommon for patients to present with hypertension, hemorrhage or other high-risk factors that require frequent assessments to ensure optimal maternal-neonatal outcomes during the birthing experience and hospital stay. Melissa Martin, a Nashville-based registered nurse who now works for GE Healthcare, is aware of the challenges that can occur in the labor and delivery department. She was hired by GE Healthcare to help deploy and manage Mural Solution for Labor and Delivery at HCA Healthcare, the first health system in the country to adopt the new technology for this purpose.

According to Martin, HCA Healthcare’s clinical care team collects information from multiple screens and accesses a variety of systems to aggregate clinical data to help them provide safe and high-quality real-time patient-centered care.

The Latest Innovation in Caring

The Mural Solution for Labor and Delivery integrates data [1] from multiple systems into a single screen, providing real-time data that can generate actionable insights, reduce response times, allow clinical teams to prioritize critical cases and track adherence to hospital-defined protocols. One of the biggest advantages of Mural Labor and Delivery as a digital tool is that it is configured to align with current national maternal safety standards for hemorrhage and hypertension, as well as hospital-defined care protocols.[2]

Mural for Labor and Delivery aggregates clinically meaningful data related to hemorrhage, hypertension and oxytocin management into a centralized clinical surveillance dashboard, while also providing timely clinical decision support once clinical data criteria are met. The solution updates the data minute by minute, offering the labor-and-delivery clinical care team opportunities to intervene as the patient’s labor process evolves.

Adopting innovative and exceptional technologies like Mural for Labor and Delivery provides clinicians with improved access to data, allowing them to spend even more time providing direct care to patients.

“With Mural, GE provides an excellent example of the possibilities of using real-time clinical data in hospitals to help reduce maternal morbidity, which is a game changer,” explains Martin, who is also the engagement leader for Mural Virtual Care Solution, the umbrella platform designed to help doctors and nurses keep track of patients in one central place.

Consider this: If a mom-to-be is hypertensive — severe hypertension in pregnancy is clinically defined as systolic blood pressure of 160 or above and/or diastolic blood pressure of 110 or above — her blood pressure should be checked every 15 minutes. Any potential lags could increase the risk of reduced blood flow to the placenta and may put the baby in danger.

Currently, when something goes wrong, it’s often hospital discharge data, not real-time clinical data, that gives healthcare providers information about maternal morbidity. Typically, hospitals frequently rely on retrospective hospital discharge data that they submit to their state department of health and/or hospital associations to identify the primary causes of severe maternal morbidity (SMM) during hospital stays. A retrospective review looks back on the patient’s care during the hospital stay to identify factors that might have contributed to a “near-miss” event, opportunities for improvement, systems-level gaps, good catches and lessons learned. Mural for Labor and Delivery now offers the labor-and-delivery clinical care team an upstream tool to help tackle hospital-based SMM and the opportunity to intervene and learn while the patient is still under their care.

Martin notes that by the time the retrospective SMM data has been reviewed by hospitals, the opportunity to intervene has been missed and the focus shifts to a future state of learning and applying as much as you can to prevent maternal near misses from occurring next time.

It’s these kinds of strategies that have led organizations like the American College of Obstetricians and Gynecologists, the March of Dimes and the Association of Women’s Health, Obstetric and Neonatal Nurses to promote evidence-based perinatal protocols such as those used by HCA to help address the public health crisis of maternal mortality.

Better Protocols Mean Better Outcomes

Hospital evidence-based standard-of-care protocols are key to improving maternal-neonatal outcomes. The virtual care solution comes at a time when maternal mortality rates are in the spotlight. Recent data [3] shows that the United States was one of two countries to report an increase in maternal mortality since 2000 and ranked last among all industrialized countries.

While there are many factors affecting maternal mortality, there is an opportunity for health systems to invest in technology that may help them reduce the risk of severe maternal mortality and morbidity during the in-hospital experience.

In light of the troubling data, the Joint Commission released new perinatal standards[4] of care for all accredited hospitals; these included prevention, early recognition and timely treatment for maternal hemorrhage and severe hypertension. The standards went into effect on Jan. 1, 2021.

Mural for Labor and Delivery provides information that clinicians can use to achieve those hospital-defined protocols. While current tools source data from multiple platforms and force clinicians to look through all the data to determine which patients need immediate care, Mural integrates all of the data into a single clinical dashboard, delivers real-time notifications, automates protocol management and color-codes information to help the healthcare team prioritize patient assessments and interventions.

The result, according to Martin: “It minimizes subjectivity and the manual workflow of retrieving and aggregating clinical data from the EMR. The labor-and-delivery clinical care team is given timely clinical data and clinical decision support to help them intervene and help improve maternal-neonatal outcomes at the bedside.”

Real-time monitoring of patients on a single platform triggers rapid responses and prevents escalations. In fact, research has shown that each 10% increase in compliance with recommended care, including perinatal standards for maternal hemorrhage, hypertension and oxytocin, may be linked with a 14% reduction in the risk of death.[5]

“Historically, it was several clicks through the EMR, several conversations with the patient’s nurse, several conversations with the charge nurse, and back to the physician,” Martin explains. “What we’re trying to do is minimize the additional tasks that need to occur in order to support an outcome that could be met much more quickly with decision support.”

GE Healthcare piloted Mural for Labor and Delivery at hospitals in Virginia and Florida. Martin notes that one of the clinicians, James Christmas, M.D., a maternal-fetal medicine specialist at Henrico Doctors’ Hospital in Richmond, Virginia, logs into the Mural dashboard for patient updates and uses the color-coded tool to help determine which patients to see first on his morning rounds.

HCA Healthcare’s hospitals participating in the pilot program also generated clear case studies highlighting the impact of real-time data to address hypertension and hemorrhage and to help improve outcomes.

“We have every data element to every action that’s been taken in an effort to improve the process and improve the outcomes, and we know it can help,” says Martin.

Providing Peace of Mind for Moms

Mural for Labor and Delivery generates actionable insights, providing hospitals with clear analytics and information about their quality metrics; the data can be presented at the unit, hospital or system level. All of this data helps hospitals and clinicians improve the quality of care, meaning peace of mind for moms who want the safest environments to deliver their babies.

“Mural Labor and Delivery is equipping and empowering the frontline labor-and-delivery clinical care team,” Martin says. “The silver lining during this pandemic is that hospitals seem to have emphasized the importance of integrating and optimizing technology. This was a big shift that can help to sustainably improve maternal-neonatal outcomes and reduce hospital-based SMM.

REFERENCES

[1] Requires real-time HL7 data feed from clinical devices.

[2] Mural is enabled by DECISIOInsight. Hospitals define and approve protocols and care areas to implement. GE does not recommend, review or assess the clinical validity of any individual protocol.

[3] Eugene Declercq and Laurie Zephyrin, “Maternal Mortality in the United States: A Primer,” Commonwealth Fund, Dec. 16, 2020, https://www.commonwealthfund.org/publications/issue-brief-report/2020/dec/maternal-mortality-united-states-primer.

[4] Joint Commission, “Provision of Care, Treatment, and Services standards for maternal safety,” R3 Report 24 (Aug. 21, 2019), https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/r3_24_maternal_safety_hap_9_6_19_final1.pdf

[5] Shahid Shafi et al., “Compliance with Recommended Care at Trauma Centers: Association With Patient Outcomes,” Journal of the American College of Surgeons 219, no. 2 (August 2014), 189–98, https://pubmed.ncbi.nlm.nih.gov/25038959/

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