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The Catalyst

SC needs to keep strong perinatal system

Dr. Patrick Cawley, CEO, MUSC Medical Center

by Patrick Cawley, M.D., CEO, MUSC Medical Center; Rita Ryan, M.D., Department of Pediatrics and David Annibale, M.D., Chief, Division of Neonatology

In medicine, teamwork is absolutely essential. Good multidisciplinary teamwork results in better communication, fewer complications, and is, in some circumstances, the difference between life and death. Caring for the smallest babies (about three pounds or less) is one of those situations.  Effective care for these patients improves outcomes in all NICU patients.

This teamwork is not easy to come by for the smallest babies. One simply needs to visit our own neonatal ICU and you quickly understand the complexity of care, staff and physicians involved. Studies show that medical centers must care for more than 100 of these babies a year to have the best results. This means fewer deaths, fewer complications and also less costly care.  Simply put, the outcomes for the smallest are best in medical centers that see enough of them. 

South Carolina currently has a robust perinatal regionalization system that has fostered improved neonatal and infant survival. This is a comprehensive, coordinated and geographically structured approach to assuring risk-appropriate care for all mothers and infants. The system is built around five high–level regional perinatal centers (RPCs) strategically located across the state. The RPCs coordinate and communicate with other medical centers licensed to provide lower levels of care to ensure access to perinatal services.

The goal is for all of these babies to be delivered in a Level III center or an RPC. In 2012, of the 942 babies born weighing approximately three pounds or less, 759 of these babies were born in Level III centers or an RPC. If you evaluate the geographic distribution, you quickly come to the conclusion that the regional perinatal system in South Carolina ensures that each of the Level III neonatal centers has sufficient volume to get the best outcomes. What would happen if that system was eliminated or modified for lower volume below the critical threshold? In Texas after the certificate of need process was eliminated, “de-regionalization” occurred. Neonatal ICU beds in the highest acuity units (“Level III”) proliferated, increasing 74 percent, yet no more tiny babies were being born in the state. Health care costs for Level III babies increased about 10 percent every year. Despite this, mortality increased for these babies. An unintended consequence of de–regionalization was a three-fold increase in the deaths of mothers. Texas is now reinstating its regionalization program.

The evidence is clear. There is no hyperbole in MUSC’s stance, nor that of the March of Dimes, the SC Children’s Hospital Collaborative and multiple professional societies that care for these babies and their mothers. We all support continuation of a strong perinatal system that is focused on what is best for patients–teams of dedicated individuals with the volume required for excellence.

March 6, 2014

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