Design Guidlines for Regional Perinatal Center

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Regional Perinatal Center The Finger Lakes Regional Perinatal Center at Strong Memorial Hospital provides comprehensive perinatal services to support regional hospitals. These services include 24-hour neonatal and obstetrical consultation, coordination of maternal and neonatal transports to the Regional Perinatal Center (RPC), participation in the regional Perinatal Forum, and outreach support visits to all affiliate hospitals. In addition, the RPC is responsible for providing support to hospita
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  Regional Perinatal Center The Finger Lakes Regional Perinatal Center at Strong Memorial Hospital providescomprehensive perinatal services to support regional hospitals. These services include 24-hour neonatal and obstetrical consultation, coordination of maternal and neonatal transports to theRegional Perinatal Center (RPC), participation in the regional Perinatal Forum, and outreachsupport visits to all affiliate hospitals. In addition, the RPC is responsible for providing supportto hospital users of the Statewide Perinatal Data System (SPDS). This includes ongoing technicalassistance and coordination of SPDS-focused committees and work groups. Requirements for the Regional PerinatalCenter New York State Department of HealthDivision of Family Health As part of the Regional Perinatal redesignation process, the New York State Department of Health has defined specific responsibilities for institutions designated “Regional PerinatalCenter.” These include many responsibilities present before the redesignation process, alongwith several important additions regarding regional QA/QI and creation of Perinatal Forums. TheDepartment of Health has included these responsibilities into the Perinatal Data System contract.What follows is taken from the New York State Department of Health Division of Family Healthrequirements for the Regional Perinatal Center.Regional Perinatal Centers responsibilities: ã Participate in quality improvement, attending level consultation, perinatalpatient transfer consultation and transport, and in meeting the training andeducation needs of perinatal affiliate hospitals. ã Implement quality improvement activities at perinatal affiliates, includingserving as the affiliate’s agent for onsite quality of care review. ã Participate in and coordinate region wide data collection, analysis, andretrieval activities among perinatal affiliate hospitals using the StatewidePerinatal Data System. ã Develop or continue the development of a Regional Perinatal Forum to striveto improve pregnancy outcomes through collaborative efforts by hospital andnonhospital representatives to increase access to perinatal care, achieveimprovements and quality of perinatal care, and to address other regionalpublic health issues related to maternal and infant health. Regional forumswill be co-chaired by the RPC and a comprehensive prenatal-perinatalservices network representative or another appropriate community-basedrepresentative.  The Department of Health considers RPC quality improvement activities to be its number one priority. The mandate extended to the RPC includes: ã Conducting outreach and education activities to all perinatal affiliatehospitals. ã Acting as each affiliate’s quality of care reviewer to conduct onsite review of the quality of care provided at each affiliate hospital. ã Identification of hospital specific or systemic problems affecting quality of care of designing and implementing measures to remedy these problems. ã Developing and implementing affiliation agreements with all associatedhospitals in compliance with current departmental regulations and acceptablestandards of perinatal care. In addition, a letter received from the Department of Health on April 10, 2002 requestedinformation on whether we receive and review records for newborn and obstetric patients other than those subject to mortality and morbidity reviews, whether we review pathology related to all perinatal deaths and significant surgical specimens at each affiliate, and whether we review andcomment on QA/QI plans and procedures/processes at each perinatal affiliate. Some of this had been done in a less formal manner during scheduled outreach visits in recent years, but it appearsthat the Department of Health is asking for a more formalized system.The New York State Department of Health is mandating a more active involvement in QA andQI activities in the region. Mechanisms have been in place in recent years for reporting of significant quality problems to the State, and for reporting of ongoing or unresolved issues between affiliate hospitals and an RPC, should such occur. What the Department of Health presently is asking is for formal reporting of the RPC’s role in QA/QI in the region. Outcomesthat result in patient transfer are routinely reviewed at outreach visits. Serious adverse outcomesthat do not result in transfer, such as fetal or maternal deaths at the affiliate hospital, should bereported to the RPC along with accompanying medical records, pathology, etc. Theseoccurrences will be discussed either at the outreach visits, or if circumstances warrant, atmeetings specifically convened for formal review. Designation Criteria (excerpted from NYSDOH Regulations 2003)[(14)](15) Level I perinatal care [program] service shall mean a comprehensive maternal andnewborn service [services program provided by a hospital designated as such by the departmentfor women who have been assessed as having a normal, low-risk pregnancy and having a fetuswhich has been assessed as developing normally and without apparent complications. A womanat low risk means a woman with a normal, medical surgical and obstetrical history and a normaluncomplicated prenatal course as determined by adequate prenatal care, and prospects for anormal, uncomplicated birth] as defined by Section 721.2(a) of this Title.[(15)](16) Level II perinatal care [program]service shall mean a comprehensive maternal andnewborn service [services program provided by a hospital designated as such by the department  for women who have been assessed as having the potential or likelihood for a complicated or high-risk delivery and/or bearing a fetus exhibiting the potential for unusual or high-risk development who may require an intermediate or intensive level of specialized care services.Such programs may also provide services to women requiring care normally provided at Level I programs] as defined by Section 721.2(b) of this Title.[(16)](17) Level III perinatal care[program] service shall mean a comprehensive maternal andnewborn service [services program provided by a hospital designated as such by the department, provided by a tertiary care hospital for women who have been assessed as high-risk patientsand/or are bearing high-risk fetuses as determined by a standardized risk assessment tool, whowill require the highest level of specialized care. Such programs may also provide services towomen requiring care normally provided at Level I and II programs] as defined by Section721.2(c) of this Title.[(17)](18) Regional perinatal [care]center (“RPC”) shall mean a [facility]hospital or hospitalshousing a Level III perinatal care [program and designated as such by the department, serving agiven designated region which provides all aspects of maternal and neonatal care and whosefunctions and responsibilities also include education, evaluation and data collection within thatregion] service as defined in Section 721.2(d) of this Title.(19) Perinatal affiliates shall mean Level I, Level II and Level III hospitals which have a current perinatal affiliation agreement with a specific RPC as defined in Section 721.11 of this Title.[(d)](c) High-risk antepartum services at Level II[and], Level III and RPC perinatal [care programs] services.(1) Level II [and], Level III and RPC perinatal [care programs]services shall develop andimplement written policies and procedures to indicate where pregnant patients with obstetric,medical, or surgical complications are to be assigned to provide for their continuous observationand care.(2) Maternal [special] intensive care services. (i) Hospitals providing Level I or II perinatal care[programs]services shall develop, enter into and implement written agreements with hospitals providing Level III and RPC perinatal care [programs]services for the transfer of obstetric patients whose physical conditions are evaluated as needing such higher level of care.(ii) Hospitals which provide multiple levels of [maternal special] perinatal care services shalldevelop and implement written protocols and procedures for the in-house transfer of patientswho are evaluated as requiring a level of care other than the level being provided in the areawhere the patient is currently located.(iii) Evaluation of the patient's condition and need for [special] intensive care services shall beconducted in accordance with standardized risk assessment criteria based on generally acceptedstandards of practice which shall be adopted in writing and implemented uniformly throughoutthe [maternity] perinatal service.  (iv) [Perinatal care programs. Hospitals] Level II, Level III and RPC perinatal care services shall[(a)] maintain a nursing staff that is appropriately trained and adequate in size to providespecialized care to distressed mothers and infants. The number of patient care staff on dutyduring any shift shall reflect the volume and nature of patient services being provided during thatshift [; and] .[(b) a regional perinatal care center] (v) An RPC shall:[(1)](a) offer education and training to [all hospitals] its perinatal affiliates and associated birthcenters [in the region which provide maternity and newborn services]. Education and trainingshall be designed to update and enhance staff knowledge and familiarity with relevant procedures and technological advances;[(2)](b) review, in conjunction with its perinatal affiliates, all cases of patients transferred to [theregional center] a higher level of care to determine whether such transfers were appropriate andaccomplished according to established transfer agreements; and[(3)](c) participate in case conferences with [hospitals]its perinatal affiliates and associated birthcenters [in the region] to determine whether any non-transferred high risk cases [which resultedin a poor pregnancy outcome] were handled appropriately and whether the transfer guidelineswere adequate to address such circumstances. For purposes of participation in such activities, theRPC representative or representatives shall be deemed member(s) of the affiliate’s qualityassurance committee. Newborns requiring extraordinary care shall be placed in a [special care nursery]NICU andhospitals shall develop and implement protocols for all phases of treatment of such newborns. Newborns [requiring extraordinary care] who are delivered in [Level 1] perinatal care[programs]services that are not capable of providing all necessary care and services shall betransferred to [Level III] perinatal care [programs]services at hospitals that can meet thenewborns’ needs.(h) [Neonatal special care services provided by Level II and III perinatal care facilities.(1) Level III perinatal care facilities which provide neonatal special care services and aredesignated as regional perinatal care centers shall provide care and services in accord with the patient care provisions of section 708.5(f)(3) of this Title.] Neonatal intensive care services.(1) Neonatal intensive care services shall be provided by Level II, Level III and RPC perinatalcare hospitals.(2) [Level II and III perinatal care facilities providing intensive and/or intermediate neonatal care but not designated as regional perinatal care centers shall provide care and services in accordwith the patient care provisions of section 708.5(f)(4) and (5) of this Title. ] Decisions regardingthe appropriate level of care and the need for transport of a neonate to a higher level of care shall be made consistent with generally accepted standards of care and the hospital’s perinatalaffiliation agreement.
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