Presentation Details
| Integrating High-Risk Obstetric Optimization Into our Bozeman Health Pre-Anesthesia Clinic: Early Outcomes and Implementation Strategy Elizabeth P.Sherman, Amy K.Mouat-Hunter. Bozeman Health, Bozeman, MT, USA |
Abstract
BACKGROUND: High-risk obstetric patients frequently present with complex comorbidities that elevate peripartum risk. At the same time, national attention on cesarean delivery rates and maternal safety underscores the need for proactive, structured medical optimization. Traditional prenatal models may not allow dedicated time for risk evaluation. To address this gap, we expanded our Pre-Anesthesia Clinic (PAC) to include a high-risk obstetric optimization pathway using perioperative assessment principles.
PURPOSE: Beginning in mid-2024, we established a referral pathway from obstetrics, maternal-fetal medicine, cardiology, and primary care for patients meeting defined risk criteria. PAC visits included anesthesia-focused medical evaluation, functional assessment, medication review, laboratory risk stratification, and individualized optimization plans. Care coordination occurred with OB anesthesia, labor and delivery, MFM, pharmacy, and surgical services.
RESULTS: Early experience with the program demonstrated that high-risk obstetric patients benefited from earlier identification of modifiable risks and more deliberate pre-delivery planning. Common themes included uncovering previously unaddressed medical concerns, initiating timely optimization (e.g., anemia management, sleep-disordered breathing evaluation, medication adjustments), and clarifying peri-delivery anesthesia considerations well ahead of labor or scheduled delivery. Clinicians across obstetrics, anesthesia, maternal-fetal medicine, and primary care consistently reported that PAC involvement improved communication, reduced last-minute uncertainty, and created clearer plans for analgesia, anesthesia, and delivery mode discussions. Patients expressed appreciation for the additional time dedicated to understanding their risks and developing individualized care plans.
CONCLUSIONS: In an era of heightened public scrutiny of C-section rates and maternal health outcomes, a structured high-risk obstetric optimization pathway within our Bozeman Health Preaneshtesia Clinic offers a scalable strategy to reduce preventable complications and enhance coordinated peripartum care. Future work will focus on refining screening criteria and measuring downstream effects on delivery mode and maternal outcomes.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: Beginning in mid-2024, we established a referral pathway from obstetrics, maternal-fetal medicine, cardiology, and primary care for patients meeting defined risk criteria. PAC visits included anesthesia-focused medical evaluation, functional assessment, medication review, laboratory risk stratification, and individualized optimization plans. Care coordination occurred with OB anesthesia, labor and delivery, MFM, pharmacy, and surgical services.
RESULTS: Early experience with the program demonstrated that high-risk obstetric patients benefited from earlier identification of modifiable risks and more deliberate pre-delivery planning. Common themes included uncovering previously unaddressed medical concerns, initiating timely optimization (e.g., anemia management, sleep-disordered breathing evaluation, medication adjustments), and clarifying peri-delivery anesthesia considerations well ahead of labor or scheduled delivery. Clinicians across obstetrics, anesthesia, maternal-fetal medicine, and primary care consistently reported that PAC involvement improved communication, reduced last-minute uncertainty, and created clearer plans for analgesia, anesthesia, and delivery mode discussions. Patients expressed appreciation for the additional time dedicated to understanding their risks and developing individualized care plans.
CONCLUSIONS: In an era of heightened public scrutiny of C-section rates and maternal health outcomes, a structured high-risk obstetric optimization pathway within our Bozeman Health Preaneshtesia Clinic offers a scalable strategy to reduce preventable complications and enhance coordinated peripartum care. Future work will focus on refining screening criteria and measuring downstream effects on delivery mode and maternal outcomes.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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