For every pregnant woman with a severe underlying maternal condition in the Netherlands, the right care in the right place is essential to aim for the best perinatal outcome for both mother and child. But the tough question is when care in the second line is appropriate and when she is better treated and monitored in the third line of care.
This regional initiative aims to join knowledge and expertise and ensure that pregnant women with pre-existing maternal conditions receive appropriate care in the right place, avoid unnecessary referrals to the tertiary level if not needed, and optimise care based on individual risk profiles and situations.
The need for a standardised regional network to share expertise & propose the best maternal care
In the Netherlands, there are clear agreements for fetal care assessments (e.g. a transfer to the regional Neonatal intensive care unit centre (NICU) in case of an expected delivery before 32 weeks). However, such agreements for underlying maternal conditions are lacking (e.g. which women with underlying cardiovascular conditions should receive care in a tertiary centre).
As a result, many women are referred to the third line for antenatal care and delivery, which, given their risk profile, sometimes do not need it, and it also happens that women give birth in the second line who do not receive the right care there. This might be due to incorrect risk assessment (when looking back), necessary expertise and experience with specific conditions not being available, or insufficient logistical conditions, for example.
This might happen due to:
- incorrect assessment of the risk,
- a shortfall of expertise and experience with specific patients and their condition(s),
- not optimal logistical conditions.
To improve care for expectant mothers, Titia Lely and Steven Koenen, two Dutch gynaecologists and obstetricians, inspired by their working experience with remote care consultation in Toronto, Canada, dreamed about a regional network for pre-existing maternal diseases in pregnancy to make the best decisions for their patients regardless of complexity.
The aim towards networked collaboration, responding to the need for »The Right Care at the Right Place«
In 2021, the project “Setting up Network Maternal Diseases and Pregnancy”, initiated by the NVOG (Dutch Society for Obstetrics and Gynaecology), earned recognition from SKMS (Funds for Medical Specialists Foundation) and was carried out in the UMC Utrecht perinatal region with support from the Birth Care Consortium Central Netherlands (GCMN).
In addition to the UMC Utrecht, the GCMN comprises eight small and larger peripheral hospitals spread across central Netherlands from Deventer, Utrecht to Tilburg.
Initially, a project group was formed with gynaecologists from four of these hospitals:
- UMC Utrecht,
- Diakonessenziekenhuis,
- Antonius Hospital,
- Elisabeth Tweesteden Hospital.
Later, two more centres joined: Meander Medical Centre and Deventer Hospital.
The project aimed to develop and establish a multidisciplinary consultation (MDT) platform to discuss individual cases of pregnant women with underlying conditions. Initially, this was delineated to women with cardiac, vascular, haematological or nephrological conditions from preconception to maternity and postpartum period.
The initiative emerged from the need to address a crucial aspect of maternal care, and it aims to establish a regional network focused on maternal diseases during pregnancy, responding to the absence of clear guidelines for determining when care in the secondary or tertiary setting is necessary.
The objective is to ensure that pregnant women with serious maternal conditions receive appropriate care in the right place, avoiding unnecessary referrals to the tertiary level and optimising care based on individual risk profiles and situations.
Realising the vision with the support of Vitaly MDT solution
From June 2023, Vitaly was completely set up and ready for use in practice. The project of establishing a regional obstetricians network for MDT meetings joined forces with Data Delen Midden Nederland (DDMN), which already provided a regional collaboration platform for oncology MDT meetings that worked with different electronic health record systems (Chipsoft, Epic, EasyCare …), providing scalability in the future. In this way, the Vitaly platform was built to support secure data exchange between participating institutions before, during and after the MDT meetings take place.
Vitaly collaboration platform efficiently supports and streamlines the Obstetrics MDT process in the Central Netherlands region every month, enabling:
- Requesting physicians to open Vitaly with a single sign-on at the start and share a case request.
- Schedulers to efficiently set MDT dates and confirm the completeness of required patient data.
- Everyone involved to view the agenda, prepare the cases, and access extensive patient data by extracting it from the relevant Electronic Patient Record (EPR).
- Chairpersons to lead MDTs by presenting overview screens with real-time patient data from their
- Scribe documents MDT findings and conclusions.
- After the meeting, the minutes are approved and can be accessed live in Vitaly.
The benefits of applying a cross-organisational MDT solution
Integration of the Vitaly platform across the maternal disease and pregnancy network brings numerous benefits, both in the short and long term.
Patient benefits:
- Elevating overall patient satisfaction and experience.
- Better and more equal care options through access to the best regional expert teams.
- Increased trust in the care process due to leveraging regional expertise.
- More personalised and appropriate care journey based on shared decision-making of regional experts.
Benefits for regional MDT teams:
- Reducing administrative burdens, ensuring heightened productivity with automated MDT workflows.
- Optimised logistics, planning, and agenda setup with a versatile platform.
- Quality decision-making due to comprehensive patient information leveraged by structured data.
- Deliver high-quality care services to every patient referred to the regional MDT, transcending the confines of a single hospital.
The future vision of Obstetrics MDTs in the Netherlands
The plans for the future are to further scale up the Obstetrics MDT to the whole region and potentially over the whole Dutch nation.
But a more short-term goal is to develop products (Care paths, indication list, and implementation methodology) and make them available in 2024.