COLORADO PERINATAL CARE COUNCIL
A. MEETING
B. DATE
C. LOCATION
Colorado Perinatal Care Council, Meeting#: 215
May 16, 2014
Parkview Medical Center
Pueblo, Colorado
D. PARTICIPANTS:
MEMBERS, GUESTS AND EXECUTIVE COMMITTEE MEMBERS PRESENT:
Steve Holt, MD, Rose Medical Center, CPCC Chairman
Judy Smith, Heart of the Rockies Regional Medical Center
Deb Bopp, Memorial Hospital, University South
Courtney Cryer, Montrose Memorial
Carri Montgomery, Platte Valley Medical Center
Sally Garcia, St. Anthony North
Paulette Mapes, St. Mary Corwin
Natasha Mondragon, Nurse Family Partnership
Susan Clarke, Children's Hospital Colorado
Elizabeth Whitley, MD, CDPHE
Kirk Bol, CDPHE
Lisa McCullough, Parkview Medical Center
Jenny Lowenfish, Memorial Star Transport
Stefanie Leonard, Children's Hospital Colorado Flight for Life
Amber Breyfogle, Flight for Life Colorado
Susan Wilczynski, St. Mary Corwin
Maria Telfer, St. Mary Corwin
Georgia Gardner, Nurse Family Partnership
E. HANDOUTS (Available Upon Request)
1. Agenda
2. Conference Calendar
3. CPCC Meeting Dates & Locations - 2014
4. Self-Assessment Survey Summary
5. Meeting Minutes
6. Community Program Handouts
F. SUMMARY OF THE MEETING
1. Procedural Items
a. The Council thanked Pat Pate for hosting the meeting and providing the meeting room,
snacks and refreshments.
b. Introduction of Council members and guests.
c. The Minutes from the March 21, 2014 meeting were reviewed and approved
d. The Treasurer’s Report was provided by Sandra Gardner, CPCC Treasurer.
e. Additional conferences were noted at the meeting: For a list of upcoming conferences, please
refer to the Council’s website at: www.coloradoperinatalcarecouncil.com.
f. Executive Committee Report:
CPCC Executive Committee is looking at our current structure and continuing to define the
visions and goals of CPCC for the future. We would like to focus on more state collaborative
efforts and establish more key partnerships. CPCC Exec Committee is still looking for a new
Chairman Elect. Dr. Liz Whitley (CDPHE) and Dr. Rachel Wright (Neonatologist, Denver
Health) have now joined the Executive Committee. Pat Bohling-Smith and Vicki Lemmon
have both resigned their roles on the Executive Committee, so we will be looking for a new
Executive Committee member.
The Executive Committee is currently working on the upcoming agenda for the July 2014
meeting. Topics will include:
 Marijuana - Laura Borgelt will be presenting
o CPCC is considering creating a task force or sub-committee to address this
issue in our state. More details to come regarding the structure of this.
o We are collecting Marijuana policies/guidelines that are currently out
there in your hospitals. Please forward to Heather any that you have that
you are willing to share.
 Quality initiatives in Colorado - Paco will present
o CPCC is looking at additional funding and grant opportunities to continue
the state collaborative initiatives.
o Presentation about what other states are doing re: quality care
collaboratives and what/how Colorado is doing
 Accountable care update - are there any access issues for mothers and babies
 Other CDPHE updates, including Legislative Updates
 If you have any agenda topics you would like Exec Committee to consider for
future meetings, please email Heather
The Executive Committee is also continue to strategize about providing outreach to smaller
community hospitals and working on establishing a system to reach out to Level I and II
hospitals to increase meeting participation through webinars and conference calls. CPCC has
defined the first wave of hospitals to reach out to:
o Saint Thomas More – Canon City
o San Luis Valley MC – Alamosa
o Arkansas Valley MC – La Junta
o Prowers Medical Center – Lamar
o Evans Army Hospital – Ft Carson
CPCC has received a grant through CDPHE to visit their sites. The purpose of the CPCC visit is
to introduce the work of the council, become acquainted with their regional providers, and to
share data specific to their regions with comparative data from regions throughout the state.
Representatives from the council, which include Maternal-Fetal Medicine, Obstetrics, NurseMidwifery and a Maternal Health Specialist from the CDPHE, would like to visit their facilities
in person this summer. CDPHE Maternal Mortality Review Committee Members who are
interested in joining CPCC on these site visits are:
Kent Heyborne, MD
Amy Nacht, MSN, CNM
Jessica Anderson, MSN, CNM, WHNP-BC
Torri Metz, MD
CPCC has also requested an additional grant from March of Dimes to provide formal outreach
initiatives in this area as well.
g. Website Update: Please visit www.cpcc.co. Please contact Heather Hagenson if you have
any ideas or resources that can be added to the website.
h. Conference Calendar: Please send Heather any 2014 conferences from your organization or
in your community
The following summaries are from the presentations from the May 16, 2014 meeting:
I. Parkview Medical Center Perinatal Services Update
Parkview presented general information regarding the perinatal services that they offer, including their
successful journey to changing their neonatal level of care.
II. Maternal Stabilization and Transport: Decision Making Process
Presented by: Stephanie Martin, DO, Southern Colorado Maternal-Fetal Medicine
Dr. Martin began her presentation by discussing the goals of maternal transport and reviewed that it's
best to avoid a neonatal transport, and transfer the mother to the facility best equipped to meet her and
the neonates needs. She reviewed that the Healthy People 2010 goal is 90% of Very Low Birth Weight
Babies (VLBW) should be born in high-risk facility. She shared national statistics regarding VLBW
babies and discussed that there are wide variations of these statistics among states. Dr. Martin discussed
the Maternal Child Health (MCH) National Performance Measure 17 which evaluates the number of
VLBW neonates born in high-risk facility. Based on this data from 52 states and jurisdictions:
 15 states essentially had unchanged rates
 23 states had improved rates
 Average improvement 8%
 Colorado in this group
 14 states showed lower rates
 4 of these remained below the all-state rate of 75% VLBW inborn
 Average decline 9%
 Iowa had notable increase
Dr. Martin reviewed the data from Colorado and shared that the rate has improved 8.9% overall from
2000-2008. The most recent rate (2008) shows that 80.5% of VLBW born in high-risk facility, while
the 20% of babies not born in high-risk facility was due to being in urban areas where competition is
high and neonatal transport is readily available. Dr. Martin also discussed the barriers to maternal
transport and the regionalization of care and how EMTALA plays a role in these transfers as well. She
reviewed the indications for maternal transfer, including other reasons for transfer such as complying
with insurance contract requirements or when a pregnant woman seeks emergency care at a facility
without obstetrical services. Dr. Martin also discussed the contraindications for maternal transfer. She
identified the key components to a successful transfer:
 Good communication between the referring facility, transport team, and receiving
facility. Written documentation or, ideally, recorded conversation with typed transcript.
 Timely response/arrival by the transport team
 Experienced and trained transport personnel to assess patient status and determine
appropriateness of transport
 Ability to provide a rapid mode of transport to the receiving facility
She then reviewed the different aspects of maternal transfers including mode of transport, documentation,
communication between the transferring provider and the receiving facility and role responsibility. Dr.
Martin also discussed the care provided to mothers in route and the required guidelines and certifications
necessary for a maternal transport. Dr. Martin concluded her presentation by reviewing the important
areas regarding maternal transports:
 Maternal transport should be considered if the facility does not have sufficient resources
to meet maternal and/or neonatal medical needs
 Outcomes for premature neonates are improved if delivery occurs at an appropriate level
facility versus neonatal transport to the appropriate facility
 The maternal transport should be coordinated between the transferring and receiving
facility and the patient accompanied by appropriately trained medical personnel
 An understanding of, and compliance with, EMTALA guidelines and relevant state
statutes is essential when transporting patients
For a copy of this presentation, please contact Heather Hagenson at
heather@coloradoperinatalcarecouncil.com
III. Neonatal Stabilization and Transport: Decision Making Process
Presented by: Mary Laird, MD, Pediatrix Medical Group, Colorado Springs, CO
Dr. Laird began her presentation by reviewing the different aspects of neonatal transport. She reviewed
the outcomes and statistics of VLBW babies after inter-facility transfers. She reviewed the different
tasks that are required of the referring hospital staff once the neonatal transfer decision has been made.
Dr. Laird outlined the preparation and stabilization steps necessary for the best outcomes. She reviewed
a sample timeline, and shared the different flight times and ambulance drive times between the various
Colorado hospitals in the southern region to Memorial Children's Hospital. Dr. Laird outlined that the
transport mode requests will be collaborative between sending and receiving facilities and
considerations include:
 What does the patient need?
 How quickly will the team reach the patient?
 Will the patient benefit from a reduced out-of-hospital time?
 Weather considerations?
 “Code 3” or “Lights and Sirens”
 Time saved vs. additional risk
She shared information from a national conference from 2013 about pediatric and neonatal transports
and the consensus conference paper that identified that time of delivery of definitive care is more
important than the speed of transfer and will require a specialized team that is equipped to deliver
definite care outside tertiary care centers. Adult air transport services and EMS crews are often not
trained or equipped to deliver interventions for a pediatric or neonatal patient. Dr. Laird then discussed
CAMTS. CAMTS is an organization of non-profit organizations dedicated to improving the quality and
safety of medical transport services, with 20 current member organizations each of which sends one
representative to the CAMTS Board of Directors. The Commission offers a program of voluntary
evaluation of compliance with accreditation standards demonstrating the ability to deliver service of a
specific quality. The Commission believes that the two highest priorities of an air medical or ground
inter-facility transport service are patient care and safety of the transport environment. Dr. Laird
reviewed the education and training that is required for this accreditation. She outlined the team
composition and provided the credentials of the Memorial Star Neonatal Transport team. She identified
the quality measures that are necessary for monitoring the care and operations of the service. Dr. Laird
presented case reviews and shared that this is an important step in monitoring the service that they
provide. At Memorial Children's, they have a multi-disciplinary, physician led case review process that
has created an environment that is collaborative and not punitive in order to identify any challenges of
neonatal transports. She concluded her presentation by providing a summary of the importan...These
include:
 If VLBW infant must be born, better in tertiary care center
 Some VLBW babies will still be born in hospitals without level III/IV NICUs and
preparation for this event is critical
 Care of infant at birth, prior to leaving birth hospital, and on transport is critical to
outcomes
 Referring hospital and transporting/accepting hospital share responsibility
 Neonatal transport teams are made up of highly trained dedicated professionals
supported by professional/accrediting organizations and their hospital
For a copy of this presentation, please contact Heather Hagenson at
heather@coloradoperinatalcarecouncil.com
IV. Southern Colorado Data Update
Presented by: Ed Donovan. MD, Neonatologist, CPCC Consultant
Kirk Bol, MSPH, CDPHE Vital Statistics Unit – Health Statistics Section
Kirk Bol and Dr. Donovan jointly presented the southern Colorado data. It was first presented that the
data was analyzed from the Health Statistics and Evaluation Branch of CDPHE through birth certificates,
death certificates, fetal death certificate (20+ wks gestation), linked birth/infant deaths and the PRAMS
survey (Pregnancy Risk Assessment Monitoring System). They reviewed the relevant measures that
accounted for each of the data sources. They reviewed the various data briefs (HealthWatch) areas that
CDPHE is monitoring (for more information about this, go to:
http://www.chd.dphe.state.co.us/topics.aspx?q=Health_Statistics_Publications). Dr. Donovan then
reviewed the Colorado Perinatal Outcomes according to 7 different regions. He reviewed the data for
each of these regions, in addition to Colorado as a whole, for antenatal steroids among births 24-34 weeks
and prematurity (<37 weeks) for these areas as well. He offered questions and insight into the data and
stressed the importance of continuing to review and monitor this data. A copy of the presentation can be
found on the CPCC website at www.cpcc.co
V. The meeting was adjourned. The next Council meeting is scheduled for July 25, 2014 at the Colorado
Department of Public Health and Environment in Denver, CO from 9am – 12pm.
Respectfully Submitted,
Heather Hagenson,
CPCC Coordinator