Philips, Tygerberg Hospital in life-saving pilot project for mothers, babies

The main objective of the trial is to increase capacity to manage high risk pregnancies and complications in the Obstetric Critical Care Unit (OCCU). By improving treatment, hospitals will be able to discharge the critically ill patients earlier after they are stabilised and receive initial treatment. As such, the aim is to improve the turnover in the maternity department.

This collaboration with Tygerburg Hospital was announced during the concluding leg of Philips' Cairo to Cape Town road show 2012, which arrived in Cape Town today, the final destination after a three-month journey, across 12 000km and seventeen cities in eleven countries in Africa. The initial discussions with Tygerburg Hospital commenced during the concluding leg of Philips' 2011 pan-African road show and exactly 12 months since then, Philips has announced the start of a range of quality improvement projects with different healthcare partners in RSA; including Tygerburg.

Addressing stakeholders at a strategic roundtable on Mother and Child care, Philips highlighted its history in South Africa; and its dedication to improving the value proposition it brings to Mother and Child care in the country through the introduction of relevant solutions, partnerships and training workshops for doctors, clinicians and healthcare workers. The main focus of the road show is on Mother and Child Care, supporting the United Nations' Millennium Development Goals (MDGs) 4 & 5 which aim to reduce child deaths by two-thirds and maternal deaths by three-quarters by 2015.

Clinical trial at Tygerberg Hospital

This clinical trial at Tygerberg Hospital is part of a larger "Quality Improvement" initiative from Philips and is the first of four programmes, focusing on the development of rural healthcare solutions throughout Africa. The overall project aims to provide infrastructure to facilitate remote and mobile diagnosis in Africa (with a specific focus on rural areas).

"Recognising that there is an urgent need to improve healthcare access in the rural areas of South Africa, Philips began exploring possible opportunities to provide technology, know-how, training and maintenance infrastructure. Our pilot with Tygerberg began as an outcome of discussions during the 2011 Philips Cape Town to Cairo road show; and is one of the supporting pilots of a bigger rural healthcare initiative by Philips Healthcare Africa," explains Jose Fernandes, district manager, Philips Healthcare Southern Africa. "To improve healthcare in rural areas, we needed to first investigate the challenges and requirements in urban hospitals, in order to make more informed and educated plans for rural demands. Dr. Langenegger intended to create a blue-print of the ideal obstetric critical care unit for all levels of hospitals in South Africa as well as the greater African region, and this concept fitted in perfectly with what we had in mind."

At the Tygerberg Academic hospital doctors often have to treat very sick and critically ill mothers and every year there is an increase in the rate of complicated admissions. The resources in the Intensive Care Units (ICUs) across the Western Cape are limited and pregnant patients sometimes have to compete with surgical, medical and trauma cases for admission to an ICU.

Although an Obstetric Critical Care Unit (OCCU) was established in 2006 in the hospital - providing infrastructure, equipment and medical personnel for early resuscitation, intensive monitoring of mothers and unborn babies as well as organ support - the demand on the OCCU and general ICU beds has increased substantially. Even though the OCCU is not a primary ventilation unit, it often has to intubate and ventilate patients in order to save their lives; this was an additional burden to already stretched resources.

Tygerburg Academic Hospital saw the potential for more patient admission and treatment in high care and intensive care units if there was an opportunity to provide the equipment needed for a "step-down unit". Patients in need for advanced monitoring could be admitted to an acute post natal "step-down unit", thereby increasing OCCU and general ICU capacity.

"Once a patient has been admitted to the OCCU or ICU, they are treated and monitored closely. Only when stable, can the patient be discharged to another unit for further treatment. The obstetric department did not have funding to purchase monitors for the step down unit and therefore observations were done manually," explains Dr Eduard Langenegger, head of the Obstetric Critical Care Unit at Tygerberg Academic Hospital. "The Philips Healthcare team assessed the impact that a step down area could have and they decided to fund a central nursing station where vital observations could take place; providing beds, installing monitors and training the medical staff."

A four-bed "step-down unit" was established at the end of 2010 with an aim to optimising the workflow and patient flow in the OCCU by implementing a patient monitoring and transport solution with "clinical decision support" (CDS) tools. Overall this has :
• Contributed to earlier treatment decisions
• A visual presentation of data reveals changes in patient status more clearly, sooner
• Contributed to improved patient safety
• Led to faster intervention resulting in better outcomes

The long-term objective of this pilot is to assess the benefits of using
• An OCCU blueprint to replicate in L2, L1 and rural hospitals in RSA and the African region, which includes monitoring solutions (mother & child (foetus) & Ultrasound solutions.
• Validate how to compare patient turnover and admissions in OCCU before and after 4-6 months
• Learn more about the current workflow and determine if :
o The use of the monitoring solutions will lead to early recognition and correct management of a critically ill mother.
o If the monitoring solutions & training will help to improve workflow and decrease the occupancy in the OCCU.

"With the capability of transferring patients that are stable, but still in need of continuous monitoring to the Acute postnatal step-down unit, we can increase our admission rate for patients that require critical care," says Dr Langenegger. "This would not have been possible without dedicated training, monitors and a central nursing station, and we hope that this project can be continued and serve as a template for other hospitals in South Africa," he concludes

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