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some situations, one reviewer was on-site, and the other surveyor participated
virtually. The department-approved survey organization collaborated with DSHS
and the hospitals to streamline functions and evaluate agendas to establish optimal
virtual survey guidelines.
The pandemic and staffing challenges continue to impact the designated maternal
hospitals. Some hospitals have responded to the challenges in varying ways,
including entering into diversion status for maternal care, leading to patients in
labor to be transferred to other hospitals, discontinuation of perinatal services, and
consolidation of maternal care with other facilities within a hospital system.
Improvement in Maternal Care
The maternal level of care rules were adopted in March 2018 with 222 hospitals
completing the designation process by September 2021. Comprehensive metrics of
improvements in maternal outcomes cannot be determined at this time. However,
DSHS has identified many small advances in processes and care through hospital
designation applications, documented plans of correction, site visits, and
discussions with hospital program staff.
DSHS has identified improvements in facility QAPI programs and systems of
maternal care coordination and collaboration, not only in the designated facilities
but also in the PCRs. The QAPI program evaluates the provision of maternal care
and emphasizes a multidisciplinary approach to continuous improvement for the
system, patient management and outcomes. The QAPI program is the core and
strength of any designation program. Implementation of a robust maternal
systemwide QAPI process is an area of opportunity throughout the state. This
requires established data elements, monitoring systems, and processes to compare
benchmarking and risk-adjusted outcomes.
An identified system strength is the Perinatal Care Regions (PCRs). PCRs are
geographically aligned with and are supported by the RAC. The PCRs have
established perinatal committees. Maternal designated facilities collaborate in these
regional committees to discuss issues that affect the system delivery of care and to
share best practices in this regional forum. The PCR committee chairs meet every
quarter to identify quality improvement initiatives that can be implemented in all 22
PCRs. Many PCR chairs attend the Perinatal Advisory Council meetings in
conjunction with the PCR meetings and may provide feedback on their quality
improvement initiatives at the PAC meeting. This strengthens the collaboration
between the PAC, PCR, hospitals, and the regional systems of care.