High-Risk Obstetrical Care Program Developed at UTHSC and Regional One Health Expands Internationally

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Giancarlo Mari, MD, second from left, and his team recently brought the OB F.A.S.T. simulation program to China. He is pictured with Danielle Tate, MD, FACOG, left, Bonnie Miller, RN, and Ravpreet Gill, MD, right.

A simulation program created by physicians at the University of Tennessee Health Science Center and Regional One Health to train health care workers to more efficiently handle obstetrical emergencies has helped improve care in Memphis and Shelby County, and is now expanding internationally.

The program was founded approximately five years ago by Giancarlo Mari, MD, MBA, FACOG, professor and chair of Obstetrics and Gynecology at UTHSC, as part of a plan to tackle the county’s high infant mortality rate. It was named OB F.A.S.T. (Obstetrical Feasible Approach to Safety Training) approximately two years ago, and has been used to train more than 500 obstetricians, nurses and residents from 15 states, including Tennessee.

Dr. Mari and a team from UTHSC and Regional One Health, where he is medical director of the High-Risk Obstetrics Program, recently took OB F.A.S.T. to China at the invitation of the Third Affiliated Hospital of Zhengzhou University in Henan Province, one of the top facilities for maternal and child health in China. During the trip, the team instructed health care workers from 36 hospitals in the province, who will then train other health care workers across the country in the program’s best practices for rapid response and delivery of quality care in emergency situations.

“For us, it is great, but it’s what you’d expect from an academic institution — to excel, not only internally, but internationally,” Dr. Mari said. “We work for UTHSC, for Regional One Health, for Shelby County. And now, the names of our department, the hospital, and the university go around the world with this program.”

Along with Dr. Mari, the OB F.A.S.T. leadership team making the trip included Danielle Tate, MD, FACOG, director; Ravpreet Gill, MD, anesthesiologist; and Bonnie Miller, RN, patient safety nurse in obstetrics and gynecology at Regional One Health.

Anesthesiologist Ravpreet Gill, MD, right, instructs health care workers from Henan Province in the protocol for OB F.A.S.T.

 

OB F.A.S.T. is a multidisciplinary program for dealing with emergencies before, during, and after delivery. It stresses teamwork, effective communication, shared decision making, and advanced knowledge of protocols for situations that require quick response.

These could include cardiac arrest, sepsis, anesthetic emergencies, respiratory distress, fetal heart rate distress, umbilical cord prolapse, breech delivery, postpartum hemorrhage and other complications.

The program is simulation based, in keeping with the latest emphasis in medical education, Dr. Mari said. “There is a big emphasis in medicine in general toward simulation,” he said. “We don’t want to learn on the patient. We want to teach before in the lab.” The training manual, which was developed by Dr. Mari and the team, is now translated into Chinese.

The invitation to present the training in China came from Genxia Li, MD, who spent time in Memphis in 2016 working with Dr. Mari. She said she was impressed with the program and invited the Memphis team to China because multidisciplinary simulation training is just being introduced there.

Dr. Li said those trained plan to bring OB F.A.S.T. back to their units. “It is expected that OB F.A.S.T. will influence more safe care in labor and delivery management in Henan Province,” she said. “I would like to thank the UTHSC team led by Dr. Mari for their efforts in bringing the OB F.A.S.T. simulation program to China. My plan as the director of OB F.A.S.T. in China is to use this program to train doctors and nurses in my hospital, which has between 15,000 and 20,000 deliveries per year, and in the entire Henan Province, which has a population of 110 million. The next step is to expand the program to other provinces. We plan to look at maternal and perinatal outcomes before and after the introduction of the program in my hospital and report those results.”

Dr. Mari is a maternal/fetal medicine specialist. He said OB  F.A.S.T. was developed in Memphis as part of measures to improve care for high-risk pregnancies and reduce the infant mortality rate. These also included developing a fellowship at UTHSC in maternal/fetal medicine to train physicians in high-risk obstetrical care, and adding a perinatal patient-safety nurse coordinator to the high-risk obstetrics program.

“Data we obtained showed that in a couple of years after we started our program to make the changes, including OB F.A.S.T., the mortality rate (for very-low-birthweight infants) decreased,” he said.

A follow-up study will compare outcomes of care from two years before and two years after the China training to determine if there is improvement.

The Memphis team received a warm welcome from physicians and health care workers at the hospital at Zhengzhou University, where the training took place.