Marina Hoffman, MSN and director of Peterson Regional Medical Center’s Baby Place, has announced that their birthing and baby unit has acquired the designations as a Neonatal Level I unit, and a maternal care level II, as certified by the Texas Department of State Health Services.
“Texas for years was among the lowest ranking in maternal care, for several reasons,” Hoffman said. “Then in Texas, we were all given a deadline of July 2021 meet certain criteria; and the packet was whole box of forms to fill out, and inspections we had to pass.”
Then the whole completed packet had to be returned to Austin.
“This means quality care for moms and babies. And we usually deliver 500-plus babies per year here.”
Hoffman said some Texas hospitals decided not to apply, but if a hospital is not so designated and they continue to deliver babies, they can’t bill Medicaid for reimbursement of their costs.
“And no hospital would continue to deliver babies for free,” she said. “We have to do this certification.”
This level of care is for moderately ill “neonates” who also may be recovering from an acute illness and no longer require intensive support. These newborns require moderately complex interventions; or have conditions such as apnea of prematurity, inability to maintain body temperature, or inability to take oral feedings.
Some hospitals may not have a designated Special Care Nursery. In these cases, SCN Level II criteria may be applied to patients in the nursery unit. A Level II facility has all of the Level I providers in addition to pediatric hospitalists, neonatologists and neonatal nurse practitioners.
Criteria for Level II nursery at time of delivery include the baby being pre-term less than 35 weeks; weight less than 2,000 grams (about 4.6 pounds); requiring IV infusion of any kind; respiratory distress with oxygen demand; temperature instability; and/or some other criteria.
The rules for care of new mothers and babies became effective March 1, 2018; and designation, once approved, had to be sent by Aug. 31, 2020.
Besides the paperwork in the application, the local staff has done numerous simulations to stay in practice, Hoffman said, including using fake blood to represent a medical emergency with a pregnant woman rushed to the operating room. Then the team was tested on what drugs to give such a patient and in what order.
The hospital already owns an electronic mannikin which can be programmed to have a baby, and their maternity team uses that piece of equipment, too.
The designation given to the hospital is specifically for this, like hospitals can be designated as a “trauma” center.
In addition, Hoffman leads “quality meetings” (Quality Assurance Performance Improvement Committee) once a month, a level higher than staff meetings; and had to submit the minutes from those meetings.
“We take minutes, and that’s where we discuss what we would have or could have done differently.”
Hoffman, who has 35 years invested in her nursing career, said, “It’s a lot of work, but at the end, we’re proud because we’re doing the right thing for our patients. We have to be at the top of our game.”
Her rhetorical question was, “What if PRMC didn’t exist here? Imagine if there were no OB services.”
This all grew out of a decision among Texas legislators that there must be minimum standards for both neonatal and maternity care. Then standards were written by groups of physicians and obstetricians; and legislation followed.
Hoffman said hospitals are ranked in Texas by Levels I, II, III and IV. The closest Level III and IV facilities to Kerrville are Methodist, University or Children’s Hospitals in San Antonio, to which PRMC sends patients when necessary; and St. David’s in Austin, when needed.
Level I neonatal care means the hospital is caring for babies 35 weeks old and up.
“Less than 35 weeks, we have to prove the baby got the same care as in San Antonio or Austin,” she said.
The state designations, once approved, are then reviewed every three years as required.
Ice storm story
Hoffman said during February’s ice storm, they had an expectant mother with a baby arriving at 34 weeks, who they normally would have sent to San Antonio. Instead, the PRMC staff delivered the baby within one hour.
But since helicopters weren’t flying and ambulances couldn’t drive on frozen roads, the Peterson staff cared for the mother and newborn for four days until they could send them to San Antonio.
Kerrville has three obstetrics/gynecology doctors who deliver babies; and four certified midwives, all on the same team.
The current Ob/Gyn doctors are Drs. Sharrel M. Carlton, Katlyn Hoover and Elizabeth Wilfong. All three practice at Peterson Women’s Associates.
The certified midwives are Jodie Baker, Annette Jones, Niessa Meier and Samantha Pierce.