Project reduces maternal death rate by more than 50% – 06/17/2023 – Health

A project by private institutions in Brazilian public hospitals has managed to reduce maternal mortality rates by more than half with team training, adoption of protocols and changes in care flows.

Launched in 2017, the “All mothers matter” project is the result of a partnership between Hospital Albert Einstein (SP), MSD pharmaceutical company and public managers. Since then, it has been implemented in 33 hospitals and health units in states such as Pernambuco, Pará, Rondônia, Ceará, Minas Gerais, Rio de Janeiro and Bahia. More than 18,000 pregnant women were monitored, and more than 1,600 professionals were trained.

The initiative gains importance in a context of rising maternal deaths from preventable causes, such as hemorrhage, hypertension that leads to pre-eclampsia, and generalized infection. In 2021, the last year with closed official data, the country recorded an MMR (Maternal Mortality Ratio) of 117.4 deaths per 100,000 live births, an increase of 57% compared to 2020. The increase was driven by the Covid pandemic -19.

The rate is more than four times higher than the average recorded in 121 leading private hospitals linked to Anahp (National Association of Private Hospitals) —of 26.9 deaths per 100,000, in 2021. United Nations, to reduce the MMR to 30 deaths per 100,000 live births by 2030.

The idea for the project came from two previous initiatives, the MSD for Mothers, which the multinational pharmaceutical company created in 2011 and which operates globally, and the Parto Adequado program, developed by the ANS (Agência Nacional de Saúde Suplementar, Einstein and the Institute for Healthcare Improvement, with support from the Ministry of Health, which aimed to reduce cesarean rates in Brazil.

According to Mary-Ann Etiebet, global leader of the MSD for Mothers program, it is based on three pillars: training professionals for the early identification of obstetric risk to postpartum follow-up, implementing programs to improve the management capacity of institutions and expand access to medical care and awareness among the general population.

Currently, the project is in its third phase, in six hospitals and eight primary health care units in Salvador and Feira de Santana, Bahia. Between August 2021 and February 2023, the drop in the rate of maternal deaths from direct causes in these institutions was 59%.

In the first phase, at Hospital Agamenon Magalhães, in Recife (PE), the reduction in deaths was 54.6% in the period of one year. In the next stage, the initiative involved 19 public hospitals in seven states, with a 57% drop in maternal mortality in two years.

At the Hospital Estadual da Criança, in Feira de Santana, the reduction in maternal mortality between 2021 and the beginning of 2023 was 72%, more than double the initial target, which was 30%, according to Larissa Paiva, nursing coordinator at obstetrics.

She says that, from the meetings and exchanges with the project technicians, the team noticed that it needed to better organize the care processes.

“We started with alert scores [a partir de parâmetros como pressão arterial, frequência respiratória e temperatura] that predict an early deterioration of the pregnant woman, and we manage to intervene before it gets worse”, he says.

In addition, kits were created with medications and other specific supplies for each type of obstetric complication, which are located in the sectors that will receive the pregnant woman. “We have the hypertension, postpartum hemorrhage, sepsis box. The use of these kits makes us assist this pregnant woman as quickly as possible.”

Before, according to Paiva, there was no such separation, and the team would look for medication in the emergency trolleys or in the hospital’s satellite pharmacies, which increased the time spent on patient care.

Paiva says that, as a result of the project, the hospital also began to dialogue with the managers of 71 municipalities, for which the institution is a reference in high-risk deliveries, helping to train professionals.

“In Brazil we have a ‘gap’ in prenatal care, especially for high-risk pregnant women. Either they don’t have an ideal follow-up by a medical and nursing team, they don’t receive all the guidance about the risk, or they abandon it, don’t go to all appointments”, says Claudia Garcia de Barros, executive director of the Einstein Office of Excellence.

In addition to updating protocols, standardizing care, training maternity professionals, the project also extended this work to primary care and Samu professionals, who transport the woman to a hospital.

“We still see care practices of both nurses and doctors that are a little outdated”, says Lívia Pedrillo, quality and patient safety consultant at the Einstein.

Claudia Barros says that it is difficult for nurses to make a decision without the doctor being present. “When we redesign practices and train the entire multidisciplinary team, including the doctor, he comes to understand that some issues, such as starting the process of collecting information to identify the pregnant woman’s risk score, can be done by any one of the team.”

Barros says that the project’s biggest effort has been to review these processes and make professionals understand that certain practices they learned in their training are not necessarily the best.

The project also proposes a revision of the map of hospital rooms to adapt the flow of patients. For example, it is still common for pregnant women to arrive at a crowded emergency room and there is no defined flow that prioritizes their care.

“Many hospitals are old, they were made out of order. Often the pregnant woman is lost in the midst of other complications and seriousness, with people with cardiac arrest. These issues consume time, and time, is life”, says Claudia Barros.