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New york state department of health
bureau of women's health regional perinatal centers
Goal of Regional perinatal centers
To improve perinatal outcomes by:
- Promoting access to appropriate levels of quality health care to pregnant women, newborns and postpartum women
- Implementing quality improvement programs within the RPC and among affiliate hospitals, including the implementation of the Statewide Perinatal Data System (SPDS)
- Facilitating regional perinatal forums to support local planning, identification of issues, coordination of services and recommendations for improvements
Regional Perinatal Center Responsibilities
Provision of Patient Care +
- Provide all aspects of perinatal care including all subspecialty services, laboratory supports, and medical/diagnostic imaging services needed by pregnant women, newborns and postpartum women.
- Ensure the availability of pediatric cardiac surgery in less than four hours after birth 24-hours a day, seven days a week.
- In order to provide the highest level of guidance for perinatal health issues both internally and among affiliates, the Chiefs of Normal Nursery and the Neonatal Intensive Care Unit (NICU) must be Board Certified in Neonatal Medicine and the Chief of Obstetrics must be Board Certified in Maternal-Fetal Medicine. The Chiefs must jointly coordinate perinatal services in order to ensure the provision of a continuum of high quality perinatal services.
- Ensure that personnel in house are qualified to manage any type of emergency 24-hours a day, seven days a week.
- If two or more hospitals jointly form an RPC, each hospital must have the ability to provide the same, high level of patient care to all pregnant women, newborns and postpartum women.
Provision of Consultation and Support to Affiliate Hospitals +
- Ensure all affiliates have an understanding of the types of patients they are able to care for at their facility, and that affiliates are aware of when patients may need RPC consultation and transfer. This includes the affiliate providing guidance to their medical staff regarding the triage of high-risk pregnant patients to a more appropriate level of care when indicated.
- Provide 24-hour consultation and subspecialty services to all affiliates and ensure affiliates have an understanding of the procedure to access timely consultation.
- Coordinate or perform transfers of high-risk pregnant women, newborns and postpartum women to the RPC or facility with an appropriate level of care. The affiliate must be aware that regardless of whether the patient will be transferred to the RPC, the RPC must be consulted and notified of the transfer.
- Have the capability of initiating a transfer from a referring hospital within 30 minutes of the incoming call from an affiliate hospital.
Quality Improvement +
- Develop and implement plans for continuous quality improvement for all perinatal services (obstetrical and neonatal) incorporating medical as well as nursing and ancillary personnel (e.g., respiratory therapy, laboratory services, etc.). This plan must address quality improvement activities related to the RPC's provision of direct services as well as the RPC's role with the affiliate hospitals. This quality improvement plan must also contain a plan for obtaining input from affiliates regarding the services provided the affiliate by the RPC.
- Provide consultation to affiliates regarding the development and implementation of their plans for continuous quality improvement. Review all quality improvement plans and make recommendations for improvement as needed.
- Implement quality improvement activities internally as well as among affiliate hospitals including a review of:
- internal quality assurance program, policies, and procedures;
- appropriateness and timeliness of maternal and newborn consultation, referrals, and transfers;
- maternal and newborn serious adverse events or occurrences, including the following:
- maternal and newborn fatalities;
- maternal and newborn morbidity in circumstances other than those related to the natural course of disease or illness;
- maternal and newborn nosocomial infections;
- maternal and newborn high-risk procedures; and,
- pathology related to all deaths and significant procedures.
- periodic case conferences and review of selected medical records to discuss the findings and resulting improvements in the affiliate's quality of care.
- analysis of statistical date from the Statewide Perinatal Data System (SPDS) for trends and emerging issues.
- The RPC shall be deemed a member of the affiliates' quality assurance committee for purposes of this quality review.
- Provide support for affiliates for the Statewide Perinatal Data System (SPDS) as follows:
- Provide training and ongoing technical assistance to all affiliates in the implementation and use of the SPDS, including the Core and Neonatal Intensive Care Unit (NICU) modules.
- Provide education and awareness to affiliates as to the use of the SPDS data for quality improvement activities.
- Compile and review data for new and emerging trends in perinatal care and share this information at regional perinatal forums (discussed below).
Outreach and Education +
- Conduct outreach visits to all affiliate hospitals, no less than annually or more frequently if warranted, for the purposes of identifying educational needs and providing ongoing education. These visits should target perinatal (obstetrical and neonatal) medical as well as nursing staff.
- Provide periodic grand rounds available to all affiliates on perinatal issues.
- Develop and implement a process to obtain input from affiliates regarding their educational needs and the impact of the educational opportunities provided by the RPC.
- Develop additional opportunities for affiliates to receive information regarding new and emerging perinatal practices or issues such as periodic updates, web sites, self-learning modules, videotapes, etc.
Affiliation Agreement +
- Execute expeditiously a mutually-acceptable agreement with each affiliate hospital in order to:
- provide 24-hour consultation and sub-specialty services, when indicated;
- define the types of patients that are appropriate for the care provided at the affiliate hospital;
- coordinate, if not perform, transfers of high-risk mothers and newborns to the level of care they need;
- be capable of initiating a transport from a referring hospital within 30 minutes of the incoming call;
- provide technical and consultative assistance in development of the SPDS at the affiliate hospital;
- routinely review and recommend improvements in the affiliate's quality of care, including the affiliate's:
- internal quality assurance program, policies, and procedures;
- appropriateness and timeliness of maternal and newborn referrals and transfers through a review of all cases of patients transferred to a higher level hospital and of patients retained at the affiliate hospital who met criteria for transfer to a higher level of care;
- analysis of statistical date from the SPDS;
- maternal and newborn serious adverse events or occurrences, including the following:
- maternal and newborn fatalities;
- maternal and newborn morbidity in circumstances other than those related to the natural course of disease or illness;
- maternal and newborn nosocomial infections;
- maternal and newborn high-risk procedures; and,
- pathology related to all deaths and significant procedures.
- participate in case conferences and periodic review of medical records to discuss the findings and resulting improvements in the affiliate's quality of care;
- participate in a defined dispute resolution process in situations where there is disagreement
- encourage the back-transfer of patients who no longer need RPC-level care;
- develop and implement, with support of hospitals in the region, programs of continuing and refresher education in the region;
- work with the affiliate to develop and implement policies and procedures for the recognition and immediate skillful resuscitation of a distressed newborn; and,
- share hospital SPDS data and other information as appropriate.
Regional Perinatal Forum +
- In collaboration with the Comprehensive Prenatal Perinatal Services Network (Network) in the region, convene a group to initiate the development of a regional perinatal forum.
- Develop a regional action plan, working together with the Network(s) in the area, in order to:
- identify regional problems, needed resources, and opportunities to improve quality of care;
- analyze de-identified, aggregated regional data from SPDS, when available;
- analyze other information and data as available, including vital statistics, PRAMS, community assessments, etc.;
- develop measures to implement community and hospital-based continuous quality improvement activities to enhance perinatal quality of care;
- identify training and education needed by providers and consumers and the resources needed to meet those needs..
- Provide technical assistance and support to the Department in any emerging or ongoing assistance that may be needed.
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