Care Coordination via Nurse Obstetric Intake Assessment

Learning outcomes: Participants will be able to describe a framework for a nurse obstetric intake assessment. Participants can describe how this new obstetric intake assessment coordinates obstetric care.
The care of the pregnant patient in an ambulatory care setting requires coordination amongst the care team. Having a clinic network spread across a large metropolitan area allows patients easy access to obstetric care. Patients typically visit multiple obstetricians at different clinic sites throughout their pregnancy. Standardizing and coordinating patient care is necessary to allow for this collaborative approach. Standardized care incorporates best practices to streamline workflow, facilitate continuity of care, and provide quality care. In the past year, a best-practice team created a standardized obstetric intake assessment for nurses to complete with patients via telehealth to enhance obstetric care coordination.
A best-practice team comprised of nurses, the chief obstetrician, and key members of the electronic health record (EHR) group investigated topics previously covered by clinic sites during the intake assessment, documentation in the EHR, and patient education provided to pregnant patients. The best-practice team used evidence-based research to determine which screenings to conduct and develop standard patient education. Once the content for the obstetric intake assessment was agreed upon by the clinical team, the nurses worked with the EHR group to restructure the documentation. Streamlining the EHR improves the nurses’ efficiency in the obstetric intake appointments and improves adherence to the standardized process the best-practice team developed. Education for the nursing staff was developed and rolled out by the best-practice team nurses. Virtual classes with full demonstration within the EHR were conducted. Resources were posted in an accessible electronic channel and contact points set up for questions.
In the new process, nurses conduct an obstetric intake telehealth appointment with each obstetric patient around ten weeks of pregnancy, documenting the results in the EHR. This appointment begins with creation of a pregnancy episode in the EHR, pregnancy dating, medication reconciliation, and allergy review. Next, a full medical, surgical, family, and obstetric patient history is obtained. Pertinent lab results are reviewed, and pregnancy measurements are entered. Standardized early pregnancy patient education is reviewed with the nurse and sent electronically to the patient immediately following the appointment. Three standard screenings are completed, including the Edinburgh scale, the social determinants of health (SDOH) screen, and genetics screening. By conducting these three important screens during the telehealth appointment, nurses can identify important risk factors early in a patient’s pregnancy and coordinate care to improve outcomes.
Following the roll-out of the new telehealth obstetric intake assessment process, chart audits were conducted to assess compliance with the new process. Standardizing the nurse obstetric intake assessment allows any provider within the organization access to the same baseline information for each obstetric patient. This supports the open access organizational plan, which allows patients to visit any provider in any clinic location while supporting coordinated care.