While every new mother’s postpartum experience and recovery is different, caring for a newborn while emotionally and physically healing from childbirth is always a vulnerable time in a woman’s life. Now, Healing at Home, a project inspired by the Penn Medicine Center for Health Care Innovation suggests that most women would prefer to heal after childbirth at home and that most women need ongoing support after discharge from the hospital.
A recipient of the Center’s annual Innovation Accelerator Program award, Healing at Home was conceived by Kirstin Leitner, MD, Assistant Professor of Clinical Obstetrics and Gynecology at the Hospital of the University of Pennsylvania, and Neonatologist Jessica Gaulton, MD, an Ob/Gyn Fellow at the time.
Studies show that postpartum discharge of healthy mothers and newborns can occur without increases in complication rates earlier than the current two-night length of stay in place at many hospitals, including Penn Medicine’s Hospital of the University of Pennsylvania (HUP). Recognizing this, the team of Leitner and Gaulton designed Healing at Home as a pilot program to give healthy women and their babies who have passed certain criteria the option to go home when they are ready, as opposed to the time in hospital dictated by traditional discharge time.
A collaboration between the neonatology and Ob/Gyn departments, Healing at Home allows women and babies to go home a whole day sooner. The program began as a survey of new mothers at HUP that found that an overwhelming majority of women (~80%) who had uncomplicated, routine births considered being in the hospital disruptive to both rest (a requirement after delivery) and bonding with their babies.
Speaking from personal experience, Dr. Leitner observed that most women who have just given birth want to be resting in the comfort of their home.
“I know that new mothers want to be in their own bathroom, with their own shower, surrounded by their own things,” she says. “They want to be around their other children without worrying about them being at home without them.”
Healing at Home also aims to provide all of the vital support and care needed during the postpartum period. Services include bi-directional texting which can answer questions mom may have about her own or her baby’s needs, lactation support via texting or phone calls, expedited discharge, and early postnatal depression screening.
For many women, this level of support is unprecedented. Traditionally, after giving birth, women are not seen or directly contacted by their provider for six weeks. A lot can happen in that six weeks, known as the fourth trimester, that requires careful monitoring and support. In 2018, the American College of Obstetrics and Gynecology recommended that maternal care providers contact their patients within the first three weeks post-delivery. The way the current model of pre-natal care and reimbursement to providers is presently set up does not make it feasible to offer a second postpartum visit to all new mothers.
Envisioning a way to use technology to bridge this gap and provide on-going, direct connection with patients and clinicians, women in the Healing at Home program can now enroll in a secure, round-the-clock texting service that offers continuous communication and support in real-time. This innovative technology ensures that services typically provided in the hospital are still delivered once mother and baby are home.
The texting service, or chatbot uses natural language processing and augmented intelligence to coordinate care, provide resources and address issues going on with both mother and baby all in one place. The service works by providing answers to any questions or concerns, connecting women to their providers when necessary, offering breastfeeding support, and administering depression screening through text message.
Starting with a small pilot––about 95patients— the program began testing routine questions that physicians know most patients ask to begin building out the augmented intelligence software. By testing out the technology on this small group, researchers could see where improvements needed to be made in the way that information was being delivered and worked carefully to ensure that new mothers were given the correct responses. Over a two-month period, they received more than 2,000 texts, mostly from those in need of lactation assistance.
“We answered a lot of questions by text,” Gaulton said. “For those women who had red flags, we set them up with our lactation specialists to either do a telemedicine visit or visit them in homes. There was continuity there, because those lactation specialists saw them in the hospital and they saw them at the home. They could see them multiple times, if needed.”
In addition to lactation support, the program offers new mother’s up with private nurses who visit them within 48 hours of discharge to ensure that mother and baby are doing well—a benefit covered by most insurance plans that many women do not know is available to them.
Another aspect of the program entailed making sure hospital workflows were streamlined in order to allow for earlier discharge.
Because there are many moving parts involved in discharging two patients (mother and baby) simultaneously, coordinating their care involves a highly organized and efficient process. The team came up with an extensive list of specific safety criteria for patients that determine whether or not it is safe to go home. Hospital staff utilize electronic medical records to help identify patients who have met their medical milestones in real time. If implemented across the health system, the program could reduce the hospital stay of thousands of patients by 40 percent and save over $1.5 million dollars.
“It is very important to not think of this as women going home ‘early’, because that is not the idea at all. Its really for women and their babies going home when they are ready and when they’ve met all of their criteria for passing those first few tests that prove things are going okay. Additionally, the program helps ensure women feel supported and cared for during those first few weeks recovering at home,” says Leitner.
Healing at Home is now one of four new projects taken on by Penn Medicine’s Innovation Accelerator Program, which helps bring to fruition original and creative ideas that help to improve patient care, reduce health care costs, and offer solutions to health care challenges. By streamlining inpatient workflows to decrease hospital stays and by offering personalized, high-quality at-home support, Healing at Home is changing the standard of care for new mothers and their babies.
“Not only do we want to provide women with the opportunity to go home when they feel like they’re ready, but we felt—and this is something that has happened across the United States—that there is a gap in treatment and care for women post-delivery. And we’re now encouraged to fill this gap and to support mothers more directly and immediately during their postpartum recovery,” Leitner says