Women’s and Children’s

For more than 30 years, we have been a leading provider of outsourced women's and children's services, specializing in acute inpatient care and treatment of infants and children. We continue to expand our services into pediatric intensive care, pediatric hospitalist programs and pediatric emergency medicine.

Through our demonstrated commitment to clinical excellence, we are also motivated to be an integral part of your community. We develop collaborative working relationships with community obstetricians, pediatricians, hospital nursing staffs and administration.

PremiEHR™, our proprietary EMR, captures medical information relevant to care provided in the NICU, nursery and delivery room. We also offer a turnkey, universal newborn hearing screening program called Healthy Hearing™.

Led by our dedicated on-site medical director, our locally based teams are comprised of full-time, board-certified or board-eligible physicians and ARNPs. Learn more about our women's and children's services management.

Read our posts related to women's and children's:

3 November2016

Sheridan CRNA Jobina Ruiz Featured on AANA Journal’s October Cover

Sheridan is proud that the cover of the AANA Journal’s October issue features a photo of Sheridan Certified Registered Nurse Anesthetist (CRNA) Jobina Ruiz setting up for an obstetric fistula repair surgery in Rwanda. Ruiz participated in a global anesthesia immersion experience in Rwanda with the International Organization for Women and Development (IOWD) at the beginning of this year, when she was a student registered nurse anesthetist at Northeastern University. The IOWD is a non-profit organization that, among other things, provides free treatment and care to Rwandan patients suffering from obstetric fistulae, gynecologic and pelvic floor disorders. Ruiz, who was invited to participate in the mission at the invitation of her instructor, made the trip at her own expense.

Her 16 days in Rwanda with the IOWD was a valuable and eye-opening experience. For the first few days, she worked with the gynecological surgical team on general anesthesia cases and had the opportunity to watch those patients over an extended period of time. For the rest of her stay, she worked primarily on less invasive fistula repair cases and cystoscopies under epidural and spinal anesthesia. 

Working with the IOWD volunteers and local clinicians in Rwanda was both challenging and exciting. It provided Ruiz with many new learning opportunities, for example, administering anesthesia drugs such as halothane and sodium thiopental that are no longer used in the United States. Language barriers sometimes made communication challenging, and learning about the cultural differences between Africa and the U.S. was fascinating but also could be frustrating, such as the local cultural bias against using extreme measures to save the lives of critically ill neonates. But Ruiz fell in love with Africa and the people she met there – especially the women whose pain she helped manage during obstetric fistula repair surgeries. 


Jobina Ruiz draws blood from a Rwandan woman’s anti cubical vein as an anesthesiologist places an epidural to administer a blood patch

Fistula, a hole in the wall between a woman’s bladder and vagina, is a terrible condition found in women who have experienced a prolonged and obstructed labor without medical assistance, or sometimes as a result of injury to the bladder during a difficult surgery. This hole causes constant urine leakage. If the rectal wall is also affected, the woman also has no control over her feces. Ruiz learned that Rwandan women with untreated obstetric fistula are ostracized by their husbands and shamed by society, becoming social outcasts.

These women were incredibly grateful for the help of the surgical team volunteers, looking at them with eyes filled with hope and saying in their native language, “You’re going to fix me!” Ruiz said she’s equally thankful for having had the opportunity to meet and help them. “I helped these women,” she explained, “but in return they taught and helped me so much more! I am a better person because of them and this experience, and I am extremely grateful I was able to go.” She also appreciates the experience of having to make do with very limited supplies, equipment and drugs: “It taught me what I’m capable of.” Ruiz, who is well traveled, said she is anxious to return to Rwanda, next time with her husband.

She joined Sheridan in early September, immediately after passing her CRNA exam, and works at Memorial Regional Hospital in Hollywood, Florida. Prior to returning to school to earn her graduate degree and CRNA certification, she worked as a critical care registered nurse at the Mayo Clinic in Scottsdale, Arizona and NYU Langone Medical Center, Beth Israel Medical Center, New York-Presbyterian Hospital and Midtown Surgery Center in Manhattan, New York.

She hit the ground running at Memorial Regional, becoming a preceptor for nursing students after just two weeks. Her favorite thing about being a Sheridan CRNA is the strong sense of community. “It’s like being welcomed into a family.”

1 November2016

What Can Be Done About the Rising U.S. Maternal Mortality Rate?

As featured in The New York Times, several recent studies have revealed that the maternal mortality rate in the United States increased by nearly 22 percent between 2000 and 2015. This is a surprising finding, given that this increase defies current global trends. For most countries, maternal mortality has declined by a third over the last 15 years. Meanwhile, the U.S. is one of just 24 countries, including South Sudan and Democratic Republic of Congo, where the maternal mortality rate has increased.

Not only does America now have a higher rate than poorer countries such as Iran, Vietnam, Russia and Romania, but the U.S also stands as a notable outlier among wealthy countries. Data show that increased maternal mortality rates are incredibly unusual for rich countries, and this disturbing upward trend is particularly surprising in a country known for its robust health care system and dedication to improved care. Nevertheless, American maternal deaths have increased from 23 to 28 deaths per 100,000 births, and per the Institute of Health Metrics and Evaluation, the maternal death rate has increased by roughly half since 1990.

What’s Behind the Rise in U.S. Maternal Deaths

The rise in maternal mortality in the U.S. may be attributed in part to an increase in heart problems and some chronic medical conditions. One possible explanation is cardiovascular disease, which despite a declining mortality rate is still the leading cause of death overall and particularly for women. Diabetes, a diagnosis that has increased sharply and now affects 21.9 million Americans as of 2014, is considered another chronic cause. Obesity is also believed to have influenced maternal mortality rates, with more than one-third of Americans categorized as obese. It makes sense that the continuous physical strain of heart disease, diabetes and obesity, added to that of a pregnancy and subsequent childbirth, have contributed to the increase in maternal mortality in the U.S.

The health care community has yet to determine the definitive origin of America’s increase in maternal mortality. Previous research focused on isolating certain factors that might affect the data – such as poor public health in the African-American community and the rise in pregnancy among older women – but the results have been inconclusive. While maternal mortality rates varied among socioeconomic groups, every group experienced a rise in maternal death. 

Reversing the Trend Will Require More Accurate Tracking, Actionable Analysis

Further research has proven difficult as tracking maternal deaths accurately is a challenge. Maternal death is defined as complications from pregnancy or childbirth that may affect a woman up to a year after giving birth. However, in some cases the immediate cause of death may not be attributed back to the recent pregnancy and, instead, might be considered isolated and unrelated ailments. The longer the interval between the child’s birth and the mother’s death, the harder it can be to accurately attribute the death to the pregnancy or childbirth.

More accurate tracking and analysis of maternal mortality in this country is needed to better understand the causes and, potentially, reverse the upward trend. The World Health Organization (WHO) has encouraged global adoption of the Maternal Death Surveillance and Response (MDSR) approach, tracking maternal deaths, conducting expert investigations and using the findings to recommend policy changes that could reduce preventable deaths. Australia, Britain and a number of other European countries have implemented national maternal review boards. But although the MDSR working group includes representatives from the United States Centers for Disease Control and Prevention, a national maternal review board does not yet exist in this country. Half of U.S. states have set up state-level review boards, but more progress is needed. Implementing a national MDSR system could be an important step toward driving down U.S. maternal mortality. 

20 October2016

Postmastectomy Radiotherapy’s Value for Patients with Early-Stage, Node-Positive Breast Cancer

The American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO) recently issued a joint clinical practice guideline update for physicians who are treating breast cancer patients who have undergone a mastectomy. The update provides additional considerations to help physicians to determine which patients might benefit from postmastectomy radiotherapy (PMRT) and focuses on the role of PMRT for contemporary patients with early-stage, node-positive breast cancer.

While PMRT is clearly indicated for patients with very high risk of local regional failure, its use is controversial for patients with earlier-stage breast cancer, especially when there are three or fewer positive nodes. The new update focuses on this key area of controversy, stating that there is strong evidence showing that PMRT reduces the risk of breast cancer recurrence, but also providing evidence-based recommendations for the use of PMRT in patients with tumors smaller than 5 cm (T1-2 tumors) and 1 to 3 positive lymph nodes, as well as in patients undergoing neoadjuvant systemic therapy (NAST) and patients with T1-2 tumors and a positive sentinel node biopsy.

The expert panel that developed the updated guideline included representatives from ASCO, ASTRO and SSO. They reviewed relevant literature published between January 2001 and July 2015, including a meta-analysis of 22 clinical trials published in 2014 that provided evidence that PMRT is highly effective at preventing local breast cancer recurrence.

The focused guideline update emphasized that both the absolute benefit of PMRT and the benefit-to-risk ratio can vary substantially from one patient to another, and that doctors should obtain multidisciplinary clinical input and carefully consider factors that could reduce the potential benefit and increase the likelihood of complications before recommending postmastectomy radiation therapy. The panel also concluded that patients must participate fully in the decision-making process, and that their values as to what constitutes sufficient benefit and how to weigh the risk of complications against that benefit in the context of the treating physicians’ best information regarding PMRT must be respected and incorporated into the final choice of treatment.

Stephen B. Edge, MD, co-chair of the expert panel, said “We still don’t have a single, validated formula that can determine who needs PMRT, but we hope that the research evidence summarized in this guideline update will help doctors and patients make more informed decisions.” 

For more detailed information, read “Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update” published in the ASCO’s, ASTRO’s and SSO’s journals, Journal of Clinical Oncology, Practical Radiation Oncology and Annals of Surgical Oncology

This approach reinforces current practices at Sheridan partner Memorial Cancer Institute (MCI) which, like most cancer facilities, faces the complex considerations in deciding whether to recommend PMRT for this subset of patients. Sheridan collaborates with MCI oncologists and surgeons as part of a multi-disciplinary discussion addressing the relative risks and benefits of PMRT for each patient. This team looks at the patient’s entire clinical picture before making a recommendation, and patients are always included in the decision-making process.

19 October2016

Sheridan’s 2016 Leadership Conference Recognizes Eight Outstanding Clinical Leaders

The annual three-day Sheridan Leadership Conference is Sheridan Leadership Academy’s flagship event. This year’s conference took place Sept. 30-Oct. 2 in Orlando, Florida and was attended by nearly 600 physician and allied health leaders. 


Strengthening the Core

President of Physician Services Robert Coward and CEO Chris Holden provided opening remarks and introduced this year’s conference theme, “Strengthening the Core,” which focused on the key attributes required to succeed as a Sheridan clinical leader. Throughout the conference, each service line held multiple breakout sessions to promote discussion and knowledge sharing of topics related to the conference theme.

New Leadership Academy Programs

This year’s conference also marked the expansion of the Leadership Academy’s programs, whose participants are nominated by their leaders. In addition to the Emerging Leaders Program that began in 2014, the Academy added two new programs this year, the Physician Chiefs Program and the Allied Health Chiefs Program. Each of the three leadership programs kicked off its first course at the conference.

The 2016 Sheridan Leadership Award Winners

One of the highlights of the conference was the awards dinner, which took place on Oct. 1. Eight outstanding Sheridan physicians were honored with 2016 Leadership Awards:

Dr. Mike Adkins, Anesthesia Services Chief of the Year

Michael Adkins has been with Valley Anesthesiology since 1994 – providing cardiac anesthesia services for 13 years, serving as medical director at an outpatient plastic surgery center, and currently is chairman of anesthesia at Banner University Medical Center-Phoenix.

He also has filled important administrative roles during his tenure, including scheduling coordinator, division manager, board member, and principal in the formation and launch of Valley’s Mobile Services Division.

He is a former board member of the Arizona Medical Association and is president-elect of the Arizona Society of Anesthesiologists. He earned his medical degree from the University of Minnesota-Minneapolis, did a surgical internship at the University of Illinois in Chicago and received training in cardiothoracic and neuroanesthesia at Stanford University.


Dr. Joseph Toscano, Emergency Medicine Chief of the Year

Dr. Toscano has been an attending emergency physician at San Ramon Regional Medical Center since 1999 and chief of the department since 2013.

He has extensive experience and expertise in the field. In the early 2000s, he was a partner and corporate medical director for Pinnacle Medical Group, which operated five urgent care clinics in California and Arizona. He lectures frequently at urgent care conferences and is on the board of directors of the Urgent Care Association of America. He has been medical director of San Ramon Regional’s occupational medicine clinic since 1999.

He graduated from Dartmouth College and earned his medical degree from the Duke University School of Medicine. He trained in internal medicine at the naval hospital in San Diego and began practicing emergency medicine during an operational tour of duty with the U.S. Navy in the early 1990s. He moved to California in 1994 and has been an EM physician there ever since.

Dr. Frank Seidelmann, Radiology Chief of the Year

Dr. Frank Seidelmann is co-founder, chairman, and visionary force driving the success of Radisphere. Dr. Seidelmann brings a wealth of experience in radiology with subspecialty expertise in MRI and neuroradiology. He has more than 25 years’ experience in interpreting MRI cases and functions as a consultant on difficult cases for radiologists and clinicians around the country. He has lectured on MRI, both nationally and internationally.

Before venturing into subspecialty teleradiology in 1996, Dr. Seidelmann co-founded a highly successful hospital and outpatient imaging center based radiology group with 20 contracts in the Midwest and central states, at one time employing more than 50 physicians, which was acquired by Med Partners and later became Team Health. He also has owned several diagnostic imaging centers in Ohio and co-founded RIS Logic, a leading radiology software company that targeted diagnostic imaging centers. RIS Logic was later acquired by Merge Healthcare in 2003. Additionally, he has held staff positions at the Cleveland Clinic Foundation and Case Western Reserve University, and has expertise in small joint imaging.

Dr. Mitchell Stern, Women’s and Children’s Chief of the Year

Mitchell Stern, MD joined what was then known as Neonatology Certified in 1987, immediately after completing his Neonatal Fellowship at Babies Hospital (Columbia Presbyterian Medical Center) in New York City. He did his residency, including a chief residency, at Brookdale Hospital Medical Center in Brooklyn, New York. He attended medical school at St. George’s University School of Medicine in Grenada, WI and attended college at Cornell University in Ithaca, New York. 

Dr. Stern joined the staff of Plantation General Hospital in 1987 and became a Director of the unit shortly after Neonatology Certified became a part of Sheridan Healthcare in 1996. Besides being the clinical and administrative leader of the PGH Level III NICU, Dr. Stern has also been the Principal Investigator in several multicentered research projects and has been involved with several committees at both the hospital and HCA Corporate Levels.

Dr. Adam Blomberg, Diamond Award Winner

Adam L. Blomberg, M.D. is the Chief of Anesthesiology for Memorial Regional Hospital in Hollywood, Florida., as well as the National Education Director for Sheridan Healthcare’s Anesthesia Division. He serves on the Anesthesia Quality Committee at Sheridan as the co-chair of the Clinical Education & Best Practice Subcommittee. He has held positions at Memorial on the Physician's Satisfaction Committee and the Multidisciplinary Peer Review Committee as well as the Co-Chair of the Surgical Services Executive Committee.

Dr. Blomberg has had numerous articles published on anesthesia trends and best practices in leading industry publications, such as the Wall Street Journal, CNN Health, ASA Newsletter, Anesthesia Patient Safety Foundation Newsletter, HealthLeaders, Managed Care Outlook and Becker’s Hospital Review. In addition, he has spent more than 15 years as the national speaker for the “Driving Responsibly” campaign.

Dr. Blomberg completed his training at Brigham & Women's Hospital, a teaching affiliate of Harvard Medical School in Boston in the Department of Anesthesiology, Perioperative and Pain Medicine. During his final year of residency, he served as Chief Resident. He is a graduate of the University of Miami School of Medicine in Miami, Florida.

Cindy Houck, CRNA, Platinum Award Winner

Cynthia Houck, CRNA joined Sheridan Healthcare in 1984 after graduating from George Washington University’s Nurse Anesthesiology Program. She has witnessed the growth of Sheridan from a small private anesthesia group to the nation’s largest anesthesia outsourcing provider.

Cynthia has served as the Chief of Allied Health at Memorial Regional Hospital, a 700-bed tertiary care level-one trauma center, since 1993. She has also been the Regional Director of Allied Health, South Florida Region since 2009. Her responsibilities include oversight of all Allied Health in Dade and Broward Counties, 14 hospitals and 6 ambulatory facilities. She was the Clinical Coordinator for SRNAs from FIU from 2006 until 2012.

In addition to her clinical duties, Ms. Houck is also co-chair of the Policy & Procedure Subcommittee for Quality Improvement


Dr. Gary Gomez, Innovation Award Winner

Dr. Gary Gomez has served as chief of anesthesiology at Memorial Hospital Miramar since 2013 and has led several clinical improvement projects. These include enhanced recovery after surgery protocols, PONV prophylaxis tools and i

ntrathecal catheter management protocols. He also was one of three lead physicians to develop the ClearPATh anesthesia patient readiness program and is currently collaborating to develop further clinical pathways as part of Sheridan/AMSURG’s nationwide initiatives.

Dr. Gomez received his medical degree from the University of Florida and is currently enrolled at UF’s executive MBA program. He lives in South Florida with his wife and three children.

Dr. Jonathan Katz, Innovation Award Winner

Dr. Jonathan Katz started with Sheridan eight years ago as a member of the cardiac team at a 227-bed hospital. He was promoted to vice chief a year later and has been a regional medical director for 1.5 years.

Dr. Katz graduated from the University of Pennsylvania School of Dental Medicine and got his medical degree from the University of Connecticut in oral and maxillofacial surgery. He completed his anesthesia residency at the University of Miami, where he served as chief resident and did his cardiothoracic anesthesia fellowship. He also worked as an attending in UM’s cardiac anesthesia subdivision and was assistant program director for the anesthesia residency.



Please join us in congratulating this year’s Sheridan Leadership Award winners.

17 October2016

Joe DiMaggio Children’s Hospital NICU Joins National Severe Bronchopulmonary Dysplasia Collaborative

The Wasie Neonatal Intensive Care Unit (NICU) at Joe DiMaggio Children's Hospital in Hollywood, Florida, was recently accepted into the national Severe Bronchopulmonary Dysplasia (BPD) Collaborative under the guidance of its medical director, Sheridan physician Bruce Schulman M.D. BPD, a chronic lung disorder of infants and children, is more common in infants with low birth weight and those who require prolonged mechanical ventilation to treat Respiratory Distress Syndrome (RDS). 

The Joe DiMaggio Children’s Hospital NICU, which provides level II and level III neonatal intensive care services, is one of only nine prestigious U.S. medical centers in the BPD Collaborative that have multidisciplinary teams dedicated to optimizing outcomes of infants and children with severe BPD. The other members of the collaborative – all academic medical centers – are:

  • Nationwide Children's Hospital – Ohio State University College of Medicine
  • The Children's Hospital of Philadelphia – Perelman School of Medicine at the University of Pennsylvania
  • The Johns Hopkins Hospital – Johns Hopkins University School of Medicine
  • Women & Infants Hospital of Rhode Island – Warren Alpert Medical School of Brown University
  • Monroe Carell Jr. Children's Hospital at Vanderbilt – Vanderbilt University Medical Center
  • Texas Children's Hospital - Baylor College of Medicine
  • Children's Mercy Kansas City – University of Missouri-Kansas City School of Medicine
  • Children's Hospital Colorado – University of Colorado School of Medicine

The mission of the collaborative is to improve the lifelong outcomes of babies who develop severe BPD by fostering collaboration and innovation in the identification and treatment through the sharing of data, the development and implementation of quality improvement initiatives, as well as fostering research protocols to address the most pressing gaps in our knowledge. 

Sheridan congratulates Dr. Schulman and his Sheridan team along with Joe DiMaggio’s Pediatric Pulmonary Medicine program and Respiratory Therapy services on being accepted into the collaborative and contributing to its important mission.  

19 July2016

Sheridan Helps NICU Boost Average Daily Census 600%

Sheridan Healthcare’s decade-long partnership with Penrose-St. Francis Health Services has helped St. Francis Medical Center upgrade to a level III NICU, increase its ADC to six times the original volume, decrease the minimum gestational age of the babies it cares for by five weeks, build its market reputation and improve the quality of care.

Penrose-St. Francis Health Services is a full-service, 522-bed acute care facility in Colorado Springs that includes Penrose Hospital and St. Francis Medical Center. Healthgrades has named Penrose-St. Francis one of “America’s 50 Best Hospitals” for nine years in a row (2008 - 2016).

About 10 years ago, Penrose-St. Francis wanted to upgrade the level II NICU at the 522-bed, not-for-profit St. Francis Medical Center facility to a higher-level unit that would provide expanded neonatal services to the Colorado Springs community. They also wanted to build their reputation among sister hospitals in the Centura Health system and also in the local market, which included two other highly respected and established hospitals. Mark Hartman, St. Francis Medical Center’s chief administrative officer, explained, “We were in a much smaller facility at the time and wanting to improve what we were doing from a NICU point of care perspective. We didn’t like seeing transfers out of our system and thought we could do more.”

Sheridan helped Penrose-St. Francis establish a successful NICU strategy based on providing high-quality, high-level neonatology services and a commitment to the local community, including relationship-building initiatives with other prominent area hospitals and local non-profits including Colorado-based Project Newborn Hope, which raises money for funding NICU projects to support at-risk mother and infant programs. Sheridan recruited two dedicated neonatologists, collaborated on program development and helped Penrose-St. Francis upgrade its St. Francis Medical Center NICU to Level IIIA care.

St. Francis adopted our proprietary PremiEHR™ web-based neonatal EHR system that gives physicians real-time information on neonatal patients and allows doctors to record consistent, searchable notes. Sheridan also helped St. Francis add a Maternal-Fetal Medicine (MFM) program for high-risk maternity care as well as 25 private neonatal bays.

By improving the hospital’s level of care, Sheridan expanded Penrose-St. Francis Health Services’ reputation in the community and with neighboring Centura Health facilities, and cultivated strong relationships with other area hospitals. The quality of NICU services attracted sister facilities and retained patients within the Centura Health system of hospitals.

As of mid-July this year, the NICU hadn’t had a central line infection in 486 days. The gestational age of the babies they care for has been pushed from 28 weeks and older to around 23 weeks. And the original average daily census of five babies, which more than doubled in the first four years, is now nearly 30 – six times the original ADC.

Mr. Hartman and Sheridan doctors talk more about how Sheridan Women’s and Children’s Services has worked with Penrose-St. Francis to achieve its goals. 

14 April2016

Allyson Kayton Addresses Senate Committee on the Need for Innovation in Neonatal Drug Therapies

Allyson Kayton, MSN, NNP-BC has tirelessly advocated for higher standards for neonatal care since her days working in Memorial Regional Hospital’s level II and level III neonatal intensive care units. Allyson was invited by Congress to address the Senate Committee on Health, Education, Labor and Pensions regarding S.2041 – Promoting Life-Saving New Therapies for Neonates Act of 2015.

Representing the National Association of Neonatal Nurses (NANN) and Florida Association of Neonatal Nurse Practitioners (FANNP), Allyson spoke extensively on the need to promote innovation in the development of neonatal research and drug therapy. Her testimony highlighted the existing treatment gap in neonatology and how ongoing research is necessary to address the challenges within the field. The bipartisan bill put forth by Senator Bob Casey (D-PA) and Senator Bill Cassidy (R-LA) would close the treatment gap by stimulating the development of safe, effective drugs for the neonatal population and providing incentives to drug sponsors who successfully develop products for neonates.

Thank you, Allyson, for your advocacy on behalf of our youngest, most vulnerable population. Your efforts are invaluable, not only to the field of neonatology, but to all prospective parents.

14 January2016

Elements of a Successful Maternal-Fetal Medicine Program

Expectant mothers have a lot on their minds, and those who are facing high-risk pregnancies are under significant stress. They require not only education and counseling but also close, ongoing medical monitoring to mitigate the risks and improve the chances of a safe and healthy delivery. A successful maternal-fetal medicine (MFM) program helps ensure that both mothers-to-be and their developing babies receive optimal care.

The Role of MFM Physicians

In its 2014 special report on the maternal-fetal medicine subspecialists’ role within a health care system, the Society for Maternal-Fetal Medicine (SMFM) defined the scope of maternal-fetal medicine as including specific elements of preconception care, specialized prenatal care, labor and delivery and associated complications, obstetric complications, maternal complications, fetal anomalies, fetal complications, fetal testing, gynecologic issues related to pregnancy and their impact on pregnancy, and postpartum care. The role of the MFM physician complements that of obstetric care providers. MFM subspecialists provide consultations, co-management or transfer of care for complicated patients.

While acknowledging that more research is needed to evaluate the impact of MFM care on outcomes, the SMFM report cited several published examples of evidence of improvement. These include primary MFM subspecialty care of high-risk patients resulting in less prematurity, lower cesarean section rates, fewer low 5-minute Apgar scores, and lower perinatal mortality rates, as well as the association of MFM-designed and -led care in a recurrent preterm birth prevention clinic with reduced rates of recurrent spontaneous prematurity and major neonatal morbidity as compared to patients treated by their primary provider.

MFM Services and Procedures

A successful MFM program should provide the following services and procedures:

  • High-Resolution, Targeted Ultrasonography - Including Tele-radiology 
  • Fetal echocardiography
  • Co-Management of multiple gestations
  • Co-Management of preterm labor and other antepartum conditions
  • Co-Management of other maternal medical conditions during pregnancy including but not limited to diabetes, hypertension, autoimmune disorders, thyroid, thrombophilia, etc.
  • Transabdominal Cerclage (TAC)
  • Assessment of Fetal Well-Being
  • Transabdominal/Transvaginal Chorionic Villus Sampling
  • Diagnostic and/or Therapeutic Amniocentesis
  • Percutaneous Umbilical Blood Sampling (PUBS)/Intrauterine Fetal Transfusion (IUT)
  • Transvaginal (McDonald or Shirodkar) and Transabdominal Cerclage
  • Preconception Counseling
  • Referral, when appropriate,  for interventional fetal surgery, including:  sacrococcygeal teratoma, congenital diaphragmatic hernia , open neural,  twin-twin transfusion and laser therapy for fetal tumors  among others

In addition, an MFM program should provide access to an extensive array of screening and diagnostic genetic tests, including:

  • Genetic Counseling and Genetic Carrier Screening
  • First Trimester Nuchal Translucency/Nasal Bone and/or Sequential Screening
  • Non-Invasive Prenatal Testing (NIPT) – Analysis of Fetal DNA in Maternal Blood

Implementation Challenges

A successful MFM program can add a lot of value for a hospital, but setting one up is often challenging. Hospitals that begin building a program without a fair amount of prior MFM-specific management experience among the leadership find it difficult to cost effectively develop and maintain all the necessary capabilities. For this reason, it's not uncommon for hospitals and health systems to rely on more experienced partners to develop and eventually manage their MFM departments; the partner's experience managing dozens of MFM programs often means the difference between profit and loss for the entire department.

Contact Sheridan Healthcare today if you would like to learn more about how we help hospitals across the country develop and manage world-class maternal-fetal medicine programs.

10 November2015

Critical Questions for Outsourcing a Newborn Hearing Screen Program

According to the American Academy of Pediatrics, hearing loss is one of the most frequently occurring birth defects. Considering this, states have taken action to ensure children are screened and treated early for hearing loss. Now, nearly all (97%) of newborns leaving hospitals receive hearing screenings.

Because the hearing screen process is relatively routine and simple to conduct, the primary challenge for hospital management is less about process optimization and more an issue of staffing and training. To solve the problem, more hospitals are turning to outsourced service providers that can manage the program with minimal financial commitment.

Entrusting a hearing screening program to a dedicated clinical services provider ensures that the program receives appropriate staffing and attention. It also frees up time and resources that hospital staff can dedicate to higher level responsibilities.

Use the checklist below when considering a partner to manage your newborn hearing program or to evaluate your current screening program. Here are some of the key program elements to review:

1. Who’s in charge?

Strong screening programs need a dedicated – and experienced – program coordinator to ensure a screening program is running efficiently and effectively. Do you have a coordinator that recruits and trains screeners themselves? Do they monitor the upkeep of your screening equipment? Are they data-driven and focused on successful test rates?

To be confident in your hearing screens, there needs to be a specialist in charge who can be trusted to professionally oversee their department. Outsourcing relieves the hospital from being responsible for purchasing and maintaining equipment, ordering supplies, and maintaining sufficient inventory.

2. Are you ensuring quality?

Quality control is in the details. There are certain questions that new parents will ask to feel confident in their hospital’s testing program: Do you employ best practices for screening and measure against key benchmarks of quality? This technology is highly specialized and is always advancing. State mandates/guidelines also may change. Outsourcing allows professionals experienced in this specialized field to make sure changes are implemented accordingly and address questions that hospital stakeholders will ask: does the program ensure coordination, oversight, accountability and sustainability? Do we have buy-in from nursery support staff and administrators?

3. Are parents satisfied with our care?

Patient experience and satisfaction are becoming increasingly important quality metrics for hospitals. Communication to new parents, in particular, must be clear and detailed. When evaluating a program, ask who communicates with families and caregivers. Communicating with pediatricians post-discharge with hearing screen results is an integral component of the newborn hearing screening program. In an outsourced program like Sheridan, hearing screeners communicate this important information to pediatricians. How is newborn hearing screening presented to families? Is information delivered accurately and confidentially?

4. Are our processes defined?

It’s important to understand how your hospital performs its hearing tests in various circumstances. For example, how are NICU and high-risk babies determined eligible or medically stable for screening? In those hospitals which use nurses to perform screens, outsourcing may prove to be more economical. In addition, relieving nursing staff of hearing screening, and the tracking and data entry that accompanies a newborn hearing screening program, allows nurses to be more present at the bedside. Not only will this improve nursing satisfaction, but may even have on impact on HCAP scores. What screening protocols are used for well-baby screening? What is the proposed timing?

5. Is our program compliant?

There are a number of regulations with which your program will need to demonstrate compliance. Does your hearing screening comply with your state’s EDHI program? Does your program employ well-qualified staff and facilitate appropriate well trained and retraining?

If you're interested in learning more about how Sheridan can help make your hospital's hearing screen program as successful as possible, we encourage you to visit our Healthy Hearing website or contact us directly.

30 October2015

Sheridan Reduces Chronic Lung Disease in NICU Patients

Chronic lung disease (CLD) is a common morbidity for infants born prematurely. CLD — also known as bronchopulmonary dysplasia — is defined as a need for supplemental oxygen or ventilator support at 36 weeks gestational age. CLD affects roughly two thirds of extremely low birth weight infants.

The rate of incidence of CLD has driven many hospitals to implement strategies to reduce its frequency in NICU patients. One popular strategy is to benchmark against Vermont Oxford Network (VON) data. The VON is a nonprofit collaboration of healthcare professionals working together to improve outcomes and increase the quality, safety and value of newborn care. The VON maintains a clinical database of information about extremely low birth weight infants and releases reports to its members with data and strategies for care improvement.

Beginning in 2008, Sheridan Healthcare undertook an improvement project aimed at reducing the incidence of CLD at its hospitals, using VON recommended practices and benchmarking data. Sheridan’s commitment to best-in-class care for premature babies and increased emphasis on teamwork have resulted in a significant drop in the rate of CLD across all NICUs in the Sheridan network.

Tackling Chronic Lung Disease in Preemies

Beginning in the second half of 2008, Sheridan began preparing for the quality improvement initiative by collecting baseline data from each of its NICUs. After a year and a half of project planning and prep work, Sheridan’s neonatology team sent out communications asking each NICU to selected one of four “potentially better practices” (PBPs) to implement (the VON prefers the term “potentially better practice” to “best practice” because it recognizes that one strategy may not work best at all hospitals). The four PBPs that Sheridan NICUs could choose from were evidence-based strategies for reducing the risk of CLD among newborns:

  • Early caffeine treatment for babies less than 1Kg (10 grams)
  • Oxygen saturation targeting at 88-95% fir babies less than 1.5Kg
  • Room air challenge testing at 32, 34 and 36 postmenstrual age
  • Antenatal steroids for babies at 23-33 weeks gestation age

NICUs implemented one PBP from Q1 of 2010 through the end of 2011 and reported their outcomes. At the start of 2012, NICUs were asked to implement all four of the PBPs. Sheridan collected data on the CLD rate and conformance rates among practices by querying their PremiEHR clinical database. The results were quantified and were then shared with each NICU in a quarterly Quality Management report. PremiEHR helped Sheridan NICUs collect the data, and the software also helped NICU nurses, doctors and therapists monitor an infant’s documented oxygen level, respiratory support and medication, and provided reminders when infants were due for challenge testing under the program.

In addition to collecting and analyzing the PremiEHR data, Sheridan’s neonatology team also conducted quality site visits. The site visits incorporated team building exercises to align the nurses, respiratory therapists and physicians. Ensuring consistent understanding of the program, goals and division of new responsibilities across the care team was critical to the success of the program. Sheridan’s team also worked with its hospitals to create an environment conducive to teamwork. For example, Sheridan encouraged hospitals to send out weekly communications to notify care teams of patients nearing CLD criteria. The increased communication ensured all care team members were informed of a patient’s status and fostered more effective distribution of care responsibilities.

The Results

Chronic Lung Disease Rate in VLBW Infants - All Hospitals

Sheridan’s neonatal improvement project was extremely successful in lowering the incidence of CLD in newborns. During the five-year-long project, Sheridan was able to drop its incidence of CLD well below VON’s mean — VON’s data shows 24 percent of extremely low birth weight infants at member NICUs are affected by CLD, while just 16 percent of Sheridan patients are affected. The baseline CLD rate for all NICUs in the Sheridan neonatal network was 37 percent in 2008, so Sheridan was able to decrease its CLD rate by nearly 57 percent.

Cumulative CLD Cases and Cost Averted - All Hospitals [Chart]

Beyond the improved care outcomes, Sheridan’s NICUs also experienced tremendous cost savings. According to the Journal of Pediatrics, the incremental cost of a CLD patient is $31,562 (as of 2013). Altogether, Sheridan NICUs were able to save 800 cases of CLD, resulting in averted costs of $25 million for Sheridan hospitals.

Sheridan’s employment of VON’s PBPs and its dedication to collaboration between NICU care team members significantly improved care for infants at risk of CLD. To learn more about Sheridan’s neonatal services, visit our neonatology page.

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