Severe complications rise sharply among women giving birth in hospitals The proportion of women who experienced seri- ous complications while giving birth in U.S. hos- pitals rose 45 percent between 2006 and 2015, according to a report released by the Agency for Healthcare Research and Quality (AHRQ). The analysis, based on data from AHRQ’s

Healthcare Cost and Utilization Project (HCUP), explored overall trends in severe maternal mor- bidity and mortality while identifying areas of particular concern. The new report indicates, for example, that rates of acute renal failure, shock, mechanical ventilation use and sepsis at delivery all more than doubled during the 10-year period. AHRQ’s new statistical brief, “Trends and

Disparities in Delivery Hospitalizations Involv- ing Severe Maternal Morbidity, 2006-2015,” provides detailed statistics on complications involving labor and delivery: The rate of severe complications increased 45

percent overall during a 10-year period, from 101 per 10,000 delivery hospitalizations in 2006 to 147 per 10,000 in 2015. Some severe conditions involved medical

procedures. In 2015, for example, blood transfu- sions occurred with more than half of deliveries among mothers who were in shock, had an amniotic fluid embolism, were experiencing a sickle cell disease crisis or had disseminated intravascular coagulation (the formation of blood clots throughout the body). One-third of deliver- ies with shock had a hysterectomy. In 2015, rates of severe maternal morbidity

were highest among poor mothers, for those over the age of 40, or uninsured or on Medicaid or lived in large urban areas. The report also underscored racial and ethnic

disparities among women who experienced severe complications. For example, although deaths decreased overall, black women were three times more likely than white women to die as a result of delivering a baby in 2015 (11 versus 4 deaths per 100,000 delivery hospitalizations, respectively). Compared with white women, severe maternal morbidity was 110 percent more likely among black women, 40 percent more likely among Hispanic women and 20 percent more likely among Asian/Pacific Islander women in 2015. To help hospitals reduce the occurrence of

severe maternal morbidity, AHRQ developed the Safety Program for Perinatal Care to improve communication and the quality of care of labor and delivery units to reduce maternal morbidity and neonatal adverse events. The toolkit builds on knowledge gained from AHRQ's Compre- hensive Unit-based Safety Program (CUSP), TeamSTEPPS team training system and patient safety and medical liability initiative demonstra- tion grants.

Surgical suite talk

From communication to collaboration to operation! by Valerie J. Dimond


n order to accommodate the changing landscape of healthcare, surgical suite/ operating room (OR) technology contin- ues to evolve as demand for these state-of- the-art rooms increases. As new discoveries in medicine give way to innovations in surgical technology, many healthcare systems have realized that the modern OR is a must if they want to offer the newest procedures, attract and retain the best staff, and remain competi- tive. Some organizations may choose to build from the ground up while others will install major upgrades to existing rooms. Healthcare Purchasing News talked with industry veter- ans about identifying specific needs, proper planning and choosing the right people and technologies to support a healthcare organiza- tion’s development goals.

For a healthcare organization that is con- sidering an OR renovation or a new build, what are the variables they need to be thinking about?

Tony Cavallaro, CEO, JACA Architects

Several variables, including the cost to renovate; if phasing is involved then the cost of lost revenue during shutdown of

some ORs; disturbance to OR schedules due to noise and vibration; and consideration re- garding if the existing space is large enough to accommodate state-of-the-art equipment or if there will be a loss of OR rooms. If new equipment is being anticipated, additional area and infrastructure upgrades may be required. Signs that indicate it’s time to make the investment include whether infec- tion control can no longer be maintained, and if a practice is recruiting a surgeon who can fill block times.

Matthew Bluette, AIA, ACHA, AICP, LEED AP, Associate at JACA Architects

For renovation projects the main driver is usually new equipment. An increasing number of surgical cases re-

quire imaging equipment in the operating room which requires additional space and


infrastructure. Robotics-assisted surgery is another growing trend that requires additional floor space so many hospitals are needing to increase the size of current operating rooms to accommodate this new equipment.

Theresa Brigden, Associate Principle, Vizient, Inc.

Organizations should begin by reviewing demographic and population data to see if there are measurable and sustained

changes taking place that would influence the type of care and services patients will need. They should also try to answer these ques- tions: Are cases being lost to other providers based on limited facilities? Is the financial impact associated with cases flat or declining despite population and demographic needs and demands? Understanding historical, cur- rent and anticipated cases and schedules for clinicians and surgeons will help determine what solution makes the best sense and the timing related to renovations.

In most cases we see the need for this type of renovation or expansion focused on improv- ing throughput. The ability to accommodate more or different case volume.

Pamela Rockow, Director of Marketing, Surgical Workflows, Getinge

The timing of any renovation decision is greatly influenced by economic considerations, hardly surprising in light of the fact that up to 65 percent

of a hospital’s revenue is generated in the OR. In simple terms, the economic impact of maintaining the status quo in the OR needs to be weighed against the anticipated incremen- tal return on investment if the decision is made to green-light a renovation project. In many instances, project approval is preceded by a thorough analysis of the op- portunity cost of channeling limited financial resources to upgrade the OR. This step is taken to determine if the earmarked funds can generate an even greater financial return or non-economic benefit if invested elsewhere in the institution.

However, as logical as this decision- making strategy appears to be in theory,

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