Championing Best Practices in Maternal Health
An advanced level of obstetrics and gynecology care is available to women living in Westchester and surrounding communities at NewYork-Presbyterian Lawrence Hospital, where Anna Burgansky, MD, Director of Obstetrics and Gynecology, is leading patient safety and quality care initiatives. The hospital has recently become the seventh campus of NewYork-Presbyterian.
“When I came on board in 2015, my vision was to make Lawrence Hospital into a star in clinical practice, quality, and patient safety and to be able to offer local community access to care that is equivalent to an academic medical center,” says
Throughout her career, Dr. Burgansky has helped to develop guidelines for perinatal care and obstetric complications and protocols for the management of obesity in pregnancy, along with serving on patient safety committees and participating in hospital-wide safety initiatives. A longtime champion of best practices in maternal patient safety and quality care, she also has played an active role in the American Congress of Obstetricians and Gynecologists (ACOG) District II Safe Motherhood Initiative (SMI).
SMI is an innovative program that aims to decrease the incidence of preventable obstetrical complications and maternal deaths in hospitals across New York State through the implementation of bundles — standardized clinical protocols that address the three leading causes of maternal death: severe hypertension, obstetric hemorrhage, and venous thromboembolism.
“We believe the SMI guidelines have been effective in addressing the maternal mortality rate in New York State,” says Dr. Burgansky. “When the SMI began in 2013, New York’s ranking was 48 out of 50 states in maternal mortality. Since then the rate has dropped and New York is now ranked at 30, with a call for action by women’s reproductive health advocates to further reduce the state’s maternal mortality rate, particularly among black women.”
Dr. Burgansky’s first priority at NewYork-Presbyterian Lawrence Hospital was to implement new and updated quality and safety guidelines. “We became a participating hospital in the SMI and began adopting the three bundles,” says Dr. Burgansky. “An important part of the implementation process was hands-on simulation training and education of nursing and physician staff aimed to improve our team’s preparedness and responses to common obstetrical emergencies. We review our progress on a monthly basis and perform audits to assess adherence to the guidelines in clinical practice. Every member of our multidisciplinary team continues to be involved in refining our safety protocols and clinical practices. This process brings the team together as each member shares his or her own experience and expertise to achieve consensus on how we can provide the best care to our patients.”
Obesity and Pregnancy
The obstetrics team has also established interventions to manage the risks associated with obesity during pregnancy, which has deleterious consequences for mother and child. “We are seeing rising rates of obesity in our patients,” says Dr. Burgansky. “One of our newer projects is counseling our patients and educating our providers about obesity as a major risk factor for complications in pregnancy. We have also adopted practice guidelines for these patients, including diabetes screenings early in pregnancy, comprehensive testing of the fetus, evaluations by anesthesiologists for additional input regarding care during labor and delivery, and the administration of prophylaxis against thrombosis.”
“We have come a long way in educating our physicians about the risk of maternal obesity, and we are doing everything we can to bring this message to our patients, who vary widely in terms of education, socioeconomic status, and the resources available to them in their community,” adds Dr. Burgansky.
The safe and effective management of pain is another goal for Dr. Burgansky and her team. “We are trying to reduce the need for pharmacologic agents for our obstetrical patients through a multimodal pain management approach that includes a combination of non-opioid medications such as acetaminophen and ibuprofen, regional anesthesia and nerve blocks, and alternative medicine therapies,” says Dr. Burgansky. “Our nurses are trained in meditation, aromatherapy, and Reiki to reduce pain and improve our patients’ overall labor and delivery experience.”
Cesarean Delivery Rates
One of the team’s key initiatives is to reduce the rate of preventable cesarean deliveries. “NewYork-Presbyterian Lawrence Hospital had one of the highest cesarean delivery rates in the state,” says Dr. Burgansky. “The high rate of cesarean deliveries was due to multiple factors, including our patient population, physician practice styles, availability of an obstetric hospitalist, management of labor progress and inductions of labor.”
“To bring about change, we examined and revised our labor management protocols based on the latest national guidelines, added additional pharmacologic and mechanical agents to enhance induction success, and standardized the administration of Pitocin to prevent uterine overstimulation,” explains Dr. Burgansky. “We also shared regular feedback about individual physicians’ cesarean and induction statistics and how they compare to their peers. We continue to review and share our overall progress with the staff on a monthly basis. Emphasis was placed on reducing the patient’s first cesarean delivery, because it is the first cesarean delivery that drives future ones. These tactics have been very successful: The total cesarean delivery rate at Lawrence Hospital has declined from 53 percent in 2013 to 40 percent in 2017.”
Providing the highest quality and safest care for mothers and their infants remains the top priority for Dr. Burgansky and her team. “Our efforts in this area are further supported by access, when necessary, to the most advanced, specialized care that is available at NewYork-Presbyterian/Columbia.” This includes Columbia’s new Mothers Center, which manages complex pregnancies where the mother has surgical or medical complications; the Carmen and John Thain Center for Prenatal Pediatrics at NewYork-Presbyterian Morgan Stanley Children’s Hospital, which provides comprehensive advanced care for pregnancies with fetal complications; as well as the Center for Prevention of Preterm Birth that offers care and interventions for pregnancies at risk for premature delivery.
“As obstetricians in our routine encounters with patients, we are responsible for the lives of two patients — the mother and her unborn child,” says Dr. Burgansky. “Through formalized programs, such as the Safe Motherhood Initiative, we in the field are finding that maternal and fetal outcomes are best served through an organized culture of obstetric safety that optimizes delivery of care.”
Burgansky A, Montalto D, Siddiqui NA. The Safe Motherhood Initiative: The development and implementation of standardized obstetric care bundles in New York. Seminars in Perinatology. 2016 Mar;40(2):124-31.