A safe prenatal journey with primary healthcare from Emirates Health Services

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Patient safety is not a new concept in the world of medicine. Tracing the origins of the Hippocratic oath to ‘do no harm’, it forms a central pillar of healthcare delivery – wrapped around patient well-being and optimal outcomes, it is a promise we make to each patient to provide the best of ourselves at each stage of their illness. It is undeniable that during daily medical practice, several errors can pose a threat to patient safety. Fortunately, many of them are preventable – they have been proven to impact health outcomes and burden healthcare resources. The subject of patient safety has grown considerably over time and many opportunities for safety nets have been identified in several contexts. The goal is to make security practice universal across all networks and for such an outcome, standardization of practice can be essential.

Every patient and every health condition requires a unique approach to ensuring safe healthcare. Through extensive research and experience over decades, many standard practice guidelines have been established to guide healthcare providers on best practices.

One of these journeys is pregnancy – the prenatal period is a vulnerable time for mother and baby, where the mother’s physiology changes dramatically. Each stage of this journey has its challenges and benchmarks.

The story goes back to human existence, with generally accepted milestones and developments for a normal pregnancy. However, this equation can become complex with various maternal, infant or co-factors requiring a specialized approach. Health officials have invested heavily in improving prenatal programs to achieve the Sustainable Development Goal of reducing maternal and newborn mortality.

Improving Maternal Outcomes in the United Arab Emirates

Emirates Health Services (EHS) has an extensive network of health centers and facilities spread across six emirates in the United Arab Emirates. We facilitate an average of 10,000 births per year. To support this cohort of patients, EHS has evidence-based policies and best practice protocols that guide our care providers to follow a process of optimal and comprehensive care for all pregnant women seeking women’s health services. in our network. This comprehensive prenatal care program ensures the well-being of pregnant patients and facilitates safe birthing practices. EHS evidence-based antenatal care guidelines encompass different stages of the antenatal period and guide care providers to a standardized method of managing patients from standard to high-risk situations.

Our program aims to improve maternal health outcomes, standardize care practices, improve the end-user experience, and positively impact the overall quality of healthcare for these patients.

Design of the new program

The Oracle Cerner team worked with EHS experts to make this vision a digital reality. Their pregnancy care solution brings together essentials and many smart tools to manage pregnant women from the initial prenatal visit through postnatal care, labor and delivery.

Primary health care is the entry point for all uncomplicated cases; it is the gatekeepers who closely monitor the population and identify those who need specialized care versus those who need to be cared for until they transition to the secondary care setting. Primary healthcare providers are strongly subscribed and would benefit from any support to facilitate documentation, decision support, risk identification, patient follow-up, etc. We realized that there was a need to create effective mechanisms to reduce the documentation burden of primary care physicians – to achieve this, Oracle Cerner Quick Visits was used. A specific quick visit is designed for each antenatal visit based on the different stages (weeks) of pregnancy, including standard documentation and visit-specific orders. This has reduced documentation and cognitive load on our physicians, standardized our care practices, and allowed for more interaction time between patients and providers.

Prior to the implementation of this program, although we had an unobtrusive and standard mode of documentation, uptake and risk review were low, and physicians practiced free-text documentation in their notes, which was not traceable and could not be linked to clinical decision support. There was no categorization of patients according to their pregnancy risk profile. We also needed smart tools to support standardization of clinical practice for all prenatal visits and implement our evidence-based escalation protocol when needed. The approach used to deliver this program was based on an identification and reporting framework, which encapsulates the various elements used in the design of this project.

We used our Oracle Cerner EHR as the platform to implement this program, which was designed after a thorough analysis of the patient’s prenatal journey and EHS protocols. It has the following main design elements:

  • Adherence to the practice: A rule has been created in the EHR that makes it mandatory to review the risk factor form at each patient’s prenatal visit. This ensures that the patient’s risk is assessed at each visit, that their category has not changed since the previous visit, and that they are still eligible to receive the appropriate management and care based on their risk profile.
  • Compliance Management – ​​Command Sets: To ensure the standardized practice of patient care, trimester-specific multi-phase order sets – including lab tests, medications, abnormality scans, etc. – have been introduced.
  • Minimum data sets: Documentation of discrete data is a fundamental requirement for creating data-driven workflows and measuring process/clinical outcomes. Creating value-driven data collection for patients and minimizing physician burnout is key to defining a minimum data set. Working with subject matter experts, we have created minimum data sets for physician and nurse documentation, defining the mandatory data elements that must be collected for each visit. This will create a rich trove of data, which can generate evidence, analyze patterns, and guide research, leading to future improvements/improvements in patient care.
  • Patient education: Trimester-specific prenatal educational content with guided documentation was implemented for prenatal nurses. This is a critical step to ensure that all patients are educated on the topics according to the defined policy for patient education, and the process is standardized across EHS.
  • Patient data information: All documented information for patient risk profiling becomes part of the patient prenatal data information. This includes patient demographics, risk profiles, prenatal travel, and other relevant information.
  • Risk assessment: A form was created for the documentation of risk factors. This form is updated according to the latest EHS guidelines and includes many antepartum risk factors.
  • Risk Notice: Once the risk has been identified in a pregnant patient, the information is visible to all clinicians accessing that patient’s record for quick notification. In each case where the patient’s chart is opened, physicians will be alerted to the patient’s current pregnancy risk category. The risk profile is stored in the patient’s record, and it can be seen by all clinicians in different EHS locations such as the emergency department and the labor/delivery room for ongoing patient management and care.
  • Risk profiling: Once a patient has documented a risk, their risk profile is created in the system. If certain risks or issues like gestational diagnosis are not documented as ICD10-CM on the form documentation, the system checks for availability and adds the issue if it has not already been documented, ensuring data consistency across the patient record.
  • Implementation of the risk protocol: The system has smart hints and prompts to integrate risk management protocols with EHS. Based on their latest risk stratification, an icon will automatically be triggered in the ED tracking shell when high-risk pregnant patients are admitted to the ED. These icons can provide any healthcare provider with a clear view of the patient’s risk category. This step ensures that high-risk pregnancies are prioritized and appropriate protocols are followed based on individual risk. In addition to the icons, the system has clinical rules to notify emergency service providers if they are opening a high or critical risk patient’s case.
  • Risk stratification: Clinical decision support rules have been created that automatically generate a risk category for the patient based on physician documentation of their risk factors. Patients are classified into risk levels based on the presence or absence of risk factors (critical/high/medium/low/none).

Data-driven information for high-risk patients

This is an effort to identify early pregnancy-related risks and guide physicians in the management of maternity patients based on their risk profile. The program can help manage situations related to high-risk or critical pregnancies by guiding the next course of action based on identified risks for effective management and care of the patient.

For a smooth and efficient transition of care, this program is integrated in all establishments of the EHS network via Oracle Cerner EHR. This program was designed to improve patient safety and standardize risk screening practices across all EHS CSP antenatal clinics.

Some achievements of this program include:

  • Early identification of risks on all projected
  • Quick notification for everything patients identified as being at risk.
  • The average referral time to hospitals was less than a week for high-risk patients, which corresponds to the EHS standard.
  • Smart algorithms assured important compliance with risk screening for all outpatient prenatal visits in EHS primary care settings.

Due to its innovative design and high impact on patient safety practices, this program received a Gold Award at the prestigious Middle East and North Africa Stevie Awards 2022.

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