Philanthropic Partnerships and Perinatal Loss:  Working across departments to address unmet patient needs presented by Tina Welke, LICSW

1. “Philanthropic
Partnerships and Perinatal
Loss: Working across
departments to address
unmet patient needs”
Tina Welke, LICSW
Mother Baby Mental Health Program
Abbott Northwestern Hospital
November 05, 2016

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• Understand importance & impact of perinatal
loss
• Emphasize what is unique about this
collaboration
• Describe pilot, desired outcome, and
implications for spread
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Objectives

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Innovation

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• Julie Daugherty- donor
• Why Julie cares about perinatal loss
• Goals and interests (ANW, ED, perinatal):
– Craft an intervention that addresses unmet patient
need (and nurture relationships)
• Thank you to Julie and Rob
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Julie’s story

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Definition of perinatal loss
• Miscarriage or spontaneous abortion-
spontaneous loss of pregnancy before the 20th
week, most often before the 12th week
• Intrauterine fetal demise (IUFD)- fetal death after
20th week of pregnancy with mother’s health
usually not in danger
• Stillborn- Birth of a baby born without any signs
of life at or after 24 weeks of pregnancy
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Context of perinatal loss
• Perinatal death is contradictory to 'natural order' of
life
• Maternal grief may be compounded by social
stigma, blame, isolation, and minimization of value
of lost life
• Grief is complicated and individualized; difficult to
identify “best practice” to address loss
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Context of perinatal loss
• Maternal distress from perinatal loss can have
intergenerational consequences
– surviving children
– subsequent pregnancies
• Perinatal death is estimated to cost $1.5 billion in US
alone
– Missed work
– Substantial economic burden for families
• Every day, >1000 families experience loss of a child
around the time of birth
– Underestimated/underreported
– Minimization of value of lost life

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• In 2015 the ANW ED cared for 146 visits related to
miscarriage for 131 unique patients.
– An average of 12.17 cases a month
– Five patients were seen 2 or more times
• 95.2% of patients were discharged from the ED
– 4 patients eloped, 1 patient was admitted to inpatient
and 1 was transferred
• 0 patients received any follow up after discharge
from ED
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2015 data on early loss in ANW ED

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• Address unmet patient need
• Advance relationship between departments
• Advance patient care and improve patient
experience
• Collaboration between ANW Foundation and
Donor
– Pride in clinical work and creation of protocol to
address perinatal loss in ED
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Perinatal Loss Pilot in ANW ED

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Patient-centered intervention
• Donor collaboration with ANW Foundation and
Mother Baby Mental Health Program to see vision
come to fruition after familial unmet needs post-
loss
• The importance of human experience- risk
compromising relationships with technology
development
• Goal: efficient, easy and effective intervention
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Intervention is about relationships
• “The most beneficial commodity that a
heath care professional can offer to a
grieving family are a non-judgmental, deep
sense of caring and personal involvement.”
Paediatric Child Health (2011)
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• Advance collaboration between departments and tap
strengths of each multi-disciplinary team
– ANW Foundation
– ANW Emergency Department
– Mother Baby Mental Health Program
– Mother Baby Center
• Determine stakeholders
• Analyze literature on perinatal loss
• Conceptualization of intervention/protocol
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Approach to address unmet patient
need

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• Literature supports that focus of early loss in
emergency department is:
– Hemodynamic stability
– Infection prevention
– Routine discharge home to collect “products of
conception” or “expelled products”
– Emotional needs of women experiencing early loss
not met or addressed
– No F/U care from ED staff, instructions to see
OB/GYN with no standards of care for psychosocial
support
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Themes of Patient Experience

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• Brief intervention in ED, led by nurses
– 30 years of reviewed literature with consensus that providing
immediate intervention after perinatal loss at any gestation
decreases levels of emotional impact on subsequent
pregnancies
• Components
– Empathic intervention
– Holding, hand/footprints, memento
– Resources for patients
– F/U post-discharge
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Protocol for ANW ED

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• Our pilot
– Protocol delivered in ANW ED
– Study effectiveness of intervention
• Model to spread system wide
• Impact on Patient and relationship with health
care team…
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Desired outcomes

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Special thank you to Julie and Rob
Daugherty!

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• Julie and Rob Daugherty
• ANW foundation
• MH/MBCSL program support
• ED partnership
• Dr. Elizabeth LaRusso
• Patients input
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Thanks…

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Thank You!
• Discussion/questions
• Please contact me with questions
Tina Welke, LICSW
Perinatal Social Worker/Therapist
Mother Baby Mental Health Program
612.863.0187