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Pregnant Woman Taking Blood Pressure At Home
About two and a half weeks ago, as confirmed cases of COVID-19 in Minnesota began to surge, Tara Gustilo, MD, the chairwoman of obstetrics and gynecology at Hennepin Healthcare, was in between patient visits when she was struck by a thought that nearly stopped her in her tracks.
“I started thinking about the central services we provide at our OB/GYN clinic. Obstetrics is one of those things where we can’t go without seeing pregnant women for months, right? And then it was, Well, what is the barrier to safely provide prenatal care virtually, whether that be over the phone or video?’”
Vital signs, Dr. Gustilo thought, could serve as the crossover on the Venn diagram of in-person visits and virtual appointments for Hennepin Healthcare’s pregnant population. What would it look like if each of its 1,300+ expecting patients were outfitted with their own blood pressure cuff and thermometer for at-home readings? A tall order for sure, but bending the ways in which we think and act during these precarious times is quickly becoming the key to survival, especially for our essential workers on the front lines of this battle.
In terms of health models, “we’re having to [approach] those in a way that’s pretty much exactly the opposite we’d normally thought about it,” she says. “Normally, the more interactions, the more people we see, the more in-person support we can provide, the better. And now … it’s exactly the opposite.”
While colleagues and leadership rallied behind her idea, momentum was slow to build due to the cancellation of elective procedures and non-urgent visits, plus the financial ask needed in acquiring the medical means. Dr. Gustilo decided to take matters into her own hands and initiated a fundraising request, spreading the message across local PR and her very own Facebook page. An excerpt from her appeal letter:
“As we get deeper into this pandemic, having a care model in which ~50% of the visits are virtual will allow us to care remotely for pregnant, COVID-positive patients who are not acutely sick. This will keep them out of our care spaces and reduce risk of exposure to others. Further, it will allow our clinicians who have been exposed but are not acutely ill to continue to work to care for our patients.”
Dr. Gustilo also directed the letter en masse within her organization, soliciting expert thoughts and ideas on a revamped prenatal care model. “Within four hours, clinicians got together and rewrote a prenatal schedule to look at which visits are crucial for in-person [i.e., ultrasounds, collecting specimens, etc.], and then created a modified schedule,” she explains. “About half of those appointments we thought we could pull off virtually if we had the vitals.”
Fundraising amounts were met within days after the renewed schedule went public, and Hennepin Healthcare is currently in the process of ordering the at-home supplies. Procurement is a challenge due to backorders but at press time, they are planning for distribution as early as next week.
“The key here is to slow the rate of infection so it doesn’t overwhelm our medical system. I’m hoping, depending on the supply chain, that within the next two weeks [prior to the predicted “peak” infection rates] we have everyone supplied,” she says. “When we got our first load of blood pressure cuffs earlier this week, I was so excited!” The system is working to prioritize which patients get their equipment first, targeting those who are seen most frequently (usually patients with late-term pregnancy) and working backwards from there.
As patient pick-ups (or deliveries) are coordinated through MyChart, Dr. Gustilo stresses the importance of registering for patient portals—particularly in times where communications change rapidly. Half of Hennepin Healthcare’s OB patient population are signed up, whereas the other half require written letters and calls, a resource-intensive effort. “The logistics of trying to get these to our patients have been one of the hardest things for us,” she says. “The other part of that is making sure everyone knows how to use the equipment.” Her team is creating training videos and literature in English, Spanish, and Somali, which will be accessible through the website.
In addition to equipment distribution, Dr. Gustilo and team are continuously exploring ways they plan to meet their patients’ needs while minimizing exposure—for example, in the case of a patient who requires an in-person visit, a portion of it would take place in the clinic’s workroom where patient and doctor continue the visit over a phone call.
This work-in-progress care model, she says, isn't just in the hands of nurses and doctors. It's a truly united effort that involves the varied minds of genetic counselors, front desk staff, back of house, social workers and mental health workers, their supply chain, website designers, and so many countless others.
While Dr. Gustilo and team lead with an innovative spirit, she’s also quick to maintain that modifications can never take the place of an expecting patient’s medical journey, punctuated with heartbeats and other exciting milestones.
“There’s some loss happening here. For me, as a provider, being in the room when a person hears a heartbeat is awesome, it’s one of those things we love about our job,” she says. “Most of us have been so focused on making sure we have physically-safe care, that we haven't had time to address these losses our patients are feeling and how we’re feeling. How can we help mitigate those losses and acknowledge them?
“I’m hoping this pandemic doesn’t overshadow the joy and experience of pregnancy, because it is truly a miraculous experience to go through and observe.”
