A Framework for Coordination between Obstetric and Pediatric Providers in Public Health Emergencies: Lessons Learned from the Zika Outbreak in the United States, 2015 to 2017

Abstract

Emergency response to emerging threats with the potential for vertical transmission, such as the 2015 to 2017 response to Zika virus, presents unique clinical challenges that underscore the need for better communication and care coordination between obstetric and pediatric providers to promote optimal health for women and infants. Published guidelines for routine maternal-infant care during the perinatal period, and models for transitions of care in various health care settings are available, but no broad framework has addressed coordinated multidisciplinary care of the maternal-infant dyad during emergency response. We present a novel framework and strategies to improve care coordination and communication during an emergency response. The proposed framework includes (1) identification and collection of critical information to inform care, (2) key health care touchpoints for the maternal-infant dyad, and (3) primary pathways of communication and modes of transfer across touchpoints, as well as practical strategies. This framework and associated strategies can be modified to address the care coordination needs of pregnant women and their infants with possible exposure to other emerging infectious and noninfectious congenital threats that may require long-term, multidisciplinary management.

Key Points

• Emerging congential threats present unique coordination challenges for obstetric and pediatric clinicians during emergency response.

• We present a framework to help coodinate care of pregnant women/infants exposed to congenital threats.

• The framework identifies critical information to inform care, health care touchpoints, and communication/information transfer pathways.

Keywords

maternal and infant health - care coordination - communication - congenital threat - public health

Note

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of Centers for Disease Control and Prevention.

• References

• 1 Kumar P, Biswas A, Iyengar H, Kumar P. Information gaps in newborn care and their potential for harm. Jt Comm J Qual Patient Saf 2015; 41 (05) 228-233
• 2 McNairy ML, Teasdale CA, El-Sadr WM, Mave V, Abrams EJ. Mother and child both matter: reconceptualizing the prevention of mother-to-child transmission care continuum. Curr Opin HIV AIDS 2015; 10 (06) 403-410
• 3 Morain SR, Wootton SH, Eppes C. A devastating delay - Zika and the implementation gap. N Engl J Med 2017; 377 (16) 1505-1507
• 4 Goldfarb IT, Jaffe E, Lyerly AD. Responsible care in the face of shifting recommendations and imperfect diagnostics for Zika virus. JAMA 2017; 318 (21) 2075-2076
• 5 Jewell JA. Standardization of Inpatient Handoff Communication. Pediatrics 2016; 138 (05) e20162681
• 6 Joint Commission Center for Transforming Healthcare. Joint Commission Center for Transforming Healthcare releases targeted solutions tool for hand-off communications. Jt Comm Perspect 2012; 32 (08) 1 ,3
• 7 Honein MA, Dawson AL, Petersen EE. , et al; US Zika Pregnancy Registry Collaboration. Birth defects among fetuses and infants of us women with evidence of possible Zika virus infection during pregnancy. JAMA 2017; 317 (01) 59-68
• 8 Adebanjo T, Godfred-Cato S, Viens L, et al. Update: Interim guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congential Zika Virus Infection—United States, October 2017. MMWR Morb Mortal Wkly Rep 2017;66(41):1089–1099
• 9 AAP Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Emergency Medicine Committee, Emergency Nurses Association Pediatric Committee. Handoffs: transitions of care for children in the emergency department. Pediatrics 2016 138. (05)
• 10 Iams JD, Donovan EF, Rose B, Prasad M. What we have here is a failure to communicate: obstacles to optimal care for preterm birth. Clin Perinatol 2011; 38 (03) 517-528
• 11 Kim BY, Patel JJ, Steele RW. Communication between obstetricians and pediatricians. Clinical Pediatrics 2018; 57 (12) 1373-1377
• 12 American College of Obstetrics and Gynecologists. ACOG Communication strategies for patient handoffs. ACOG Committee Opinion No. 517. Obstetr Gynecol 2012; 119 (02) 408-411
• 13 Oduyebo T, Polen KD, Walke HT. , et al. Update: interim guidance for health care providers caring for pregnant women with possible Zika virus exposure - United States (Including U.S. Territories), July 2017. MMWR Morb Mortal Wkly Rep 2017; 66 (29) 781-793
• 14 Chung S, Gardner AH, Schonfeld DJ. , et al. Addressing children's needs in disasters: a regional pediatric tabletop exercise. Disaster Med Public Health Prep 2018; 12 (05) 582-586
• 15 So M, Dziuban EJ, Franks JL. , et al. Extending the reach of pediatric emergency preparedness: a virtual tabletop exercise targeting children's needs. Public Health Rep 2019; 134 (04) 344-353
• 16 Middleton B, Bloomrosen M, Dente MA. , et al. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc 2013; 20 (e1): e2-e8
• 17 American College of Obstetrics and Gynecologists. ACOG committee opinion no. 587: effective patient-physician communication. Obstet Gynecol 2016; 123 (02) 389-393
• 18 Gadson A, Akpovi E, Mehta PK. Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome. Semin Perinatol 2017; 41 (05) 308-317
• 19 Kilpatrick SJ, Papile AL, Macones GA, Watterberg KL. , eds.; American College of Obstetrics and Gynecologists. Guidelines for Perinatal Care, 8th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017
• 20 Council on Children with Disabilities and Medical Home Implementation Project Advisory Committee. Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems. Pediatrics 2014; 133 (05) e1451-e1460
• 21 Genovesi AL, Olson LM, Telford R. , et al. Transitions of care: the presence of written interfacility transfer guidelines and agreements for pediatric patients. Pediatr Emerg Care 2019; 35 (12) 840-845
• 22 Starmer AJ, Sectish TC, Simon DW. , et al. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA 2013; 310 (21) 2262-2270
• 23 Abughali N, Maxwell JR, Kamath AS, Nwankwo U, Mhanna MJ. Interventions using electronic medical records improve follow up of infants born to hepatitis C virus infected mothers. Pediatr Infect Dis J 2014; 33 (04) 376-380
• 24 Tang T, Heidebrecht C, Coburn A. , et al. Using an electronic tool to improve teamwork and interprofessional communication to meet the needs of complex hospitalized patients: a mixed methods study. Int J Med Inform 2019; 35-42 ; Doi: 10.1016/j.ijmedinf.2019.04.010
• 25 Lehmann CU. ; Council on Clinical Information Technology. Pediatric aspects of inpatient health information technology systems. Pediatrics 2015; 135 (03) e756-e768
• 26 Chung PJ, Lerner CF. Incentivizing care coordination in managed care. Pediatrics 2017; 140 (03) e20172090
• 27 Cordeiro A, Davis RK, Antonelli R. , et al. Care coordination for children and youth with special health care needs: national survey results. Clin Pediatr 2018; 57 (12) 1398-1408
• 28 Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the Chronic Care Model in the new millennium. Health Aff 2009; 28 (01) 75-85
• 29 Clark J, Sansom S, Simpson BJ. , et al. Promising strategies for preventing perinatal HIV transmission: model programs from three states. Matern Child Health J 2006; 10 (04) 367-373
• 30 Bodenheimer T. Coordinating care--a perilous journey through the health care system. N Engl J Med 2008; 358 (10) 1064-1071
• 31 Liau A, Crepaz N, Lyles CM. , et al. Interventions to promote linkage to and utilization of HIV medical care among HIV-diagnosed persons: a qualitative systematic review, 1996-2011. AIDS Behav 2013; 17 (06) 1941-1962