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Pregnant patients diagnosed with placenta accreta are at increased risk for morbidity and mortality.  The need for coordinated, interdisciplinary care is critical in the patient at risk for significant bleeding during birth.  During a multidisciplinary OB Quality meeting at a Level III teaching hospital, issues related to the care of a patient with a complete previa with placenta increta led to the development of a meeting to discuss the care of complex OB patients.

The consensus of the meeting participants was that a focus should be placed on the development of a plan of care for known complex patients to maximize patient outcomes and patient satisfaction.  The Vice President of Women’s and Children’s Services and the Chief of the TGH OB/Gyn Department  established a meeting for coordination of care of the complex patient, and invited representatives from the various disciplines to attend the Complex OB Patient meeting.

During the initial meetings, the discussion focused on coordination of care, and the need for an individual or individuals to facilitate the process.  The Clinical Nurse Specialist is in a unique position to coordinate and manage the care of complex or vulnerable populations, and became an integral leader in this process. One of the first issues that the Perinatal CNS undertook was to develop a draft policy outlining the identification and coordination of care of the complex OB patient.  This draft policy was brought to subsequent meetings, and revisions were made based on input obtained from the key disciplines.  The CNS also set up a process for communicating the plan of care for the patient.  This process was discussed with the committee members, and was modified as the program evolved.  Key to this process was communication with the nursing and medical staff, as well as other disciplines such as the Blood Bank. Interventional Radiology etc.

Another component of the coordination of care of the complex OB patient was to promote a “seamless” process for the patient, so that the patient and her family were prepared and supported prior to and during hospitalization.  One way that the CNS accomplished this was by meeting with the patient, when this was feasible, to discuss the plan.  During this meeting, the CNS was able to assess the patient/family knowledge and concerns, and tailor the information and education to that patient’s needs to enhance the patient’s knowledge and involvement with her care. 

To evaluate the effectiveness of the “Complex OB Patient” program, the Perinatal CNS is monitoring patient outcomes on an ongoing basis, and is able to bring identified concerns to the OB Complex Patient meeting.  Because representatives of the various involved disciplines attend this meeting, this allows for collegial feedback, discussion, collaboration, and improvement to occur.  The role of the CNS is to facilitate the process.  It is through the team work of the various disciplines, as well as the management team that patient outcomes, including patient satisfaction, are maximized.