Initiative: Fast-track Service for High-risk Pregnancies
Institution: Khon Kaen Hospital
Problem: Maternal death from pregnancy and childbirth is still a major problem in Thailand due to inadequate labor management and the presence of associated diseases during pregnancy. Blood loss, high blood pressure and infections are the three most common causes of maternal death. Thailand has a shortage of obstetricians which leads to discrepancies in the quality of care offered by each hospital. If a problem arises during labor and the patient needs specialized care of an experienced obstetrician, she would have to be transferred to Khon Kaen Hospital. However, under the previous system, these patients were treated as general emergencies and sent initially to the accident and emergency department where they were assessed by a nurse and an emergency room doctor before being transferred to the obstetric department. As a result, patients had to provide the same information several times, causing delays in accessing the care they needed.
Solution: In order to address the problem of delays in referrals and treatment of high-risk pregnancies, Khon Kaen Hospital, which receives patients from all the hospitals in the network, created a speedy, high quality system. In order to increase access to the system and to reduce complications, the hospital developed a network of doctors and nurses to assess symptoms, diagnose and assist in emergencies, and refer high-risk pregnancies in an appropriate and timely manner. The system is evaluated periodically to ensure its continuous and effective operation. Organizing this fast-track service for high-risk pregnancies involved reducing the steps in the referral process by creating a multidisciplinary team that is highly coordinated. Furthermore, a Hotline was provided in the delivery room to eliminate unnecessary delay in the emergency room.
Impact: Since the development of a fast-track service at Khon Kaen Hospital and the associated clinical network, the model has been expanded to include 66 hospitals. Data shows that 99 per cent of high-risk pregnancies from the hospitals in the 4 provinces are now referred to larger hospitals appropriately.