Achieving a Singular Vision: Caring for Mothers and Their Children in an Integrated System

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Courtesy of University Health System

Mother Adriana Zepeda plays with Amber Isabella Zepeda, who was born premature with a host of complications, but survived with the help of the University Health System team.

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The opportunity was unexpected.

When a plan to partner with another entity on a new academic children’s hospital fell through in 2012, University Health System was already well into a major expansion project for adult services in the form of the nearly 1 million-square-foot Sky Tower. Suddenly, a number of pediatric specialists with academic partner UT Health San Antonio were in need of a place to treat patients.

But the crisis in fragmented pediatric care created another opportunity in the ongoing transformation of University Health System (UHS), said George B. Hernández Jr., University Health System’s president and CEO.

“The children’s hospital that we tried to do with the other partners would not have addressed women’s services,” Hernández said.

So the health system pivoted. For the immediate needs, UHS dedicated one of the Sky Tower floors to pediatric services, giving young acute, intensive care, and oncology patients a bright new place to heal. That floor, and the rest of the Sky Tower, filled up quickly to meet the needs of a growing population.

Those needs, along with favorable market conditions, allowed University Health System to refinance existing bonds and plan for a new Women’s and Children’s Hospital. It would expand out from the main hospital toward Medical Drive, providing integrated care for mothers, babies, and children. It would make use of new operating rooms in the adjacent Sky Tower as well as labs, kitchen, and other back-of-house operations.

“We’re building a puzzle,” Hernández said. “You don’t know how the final puzzle will look, but you must think as if you do.”

It’s important because UHS is the only locally owned, locally headquartered health system in the area, with a mission to serve the entire region. And it’s exciting because nobody foresaw this, and no one else is doing it.

The health system will  break ground November 2 on the $500 million hospital. This will be a major construction project that creates hundreds of jobs and will expand care. It will be a beautiful, modern facility.

But the new hospital also has a vital symbolic importance: as the center of a network of compassionate care that includes reaching patients in the community, collaborating with the best minds at UT Health San Antonio, and coordinating it all through the most advanced patient medical record available.

It symbolizes – and supports – University Health System’s continuing evolution toward the best patient care for all.

As health care changes, UHS changes with it. University Hospital has been updated with changes in the standard of care and the addition of the newest technology. But the standard now includes the idea that the patient’s family is as vital to care as the latest heart monitor – and families need space.

“The NICU opened in 1991, when technology was still pretty much king,” said Irene Sandate, vice president of women’s and children’s services at University Health System. That space was designed to accommodate the latest machinery that helps keep fragile babies alive. But we know more now.

“A baby knows a mom’s voice, knows a dad’s voice. A mom who’s nursing produces more breast milk when she’s near her baby. A mother holding her baby for as long as she wants, as often as she wants – that’s the ideal,” Sandate said. “When a baby leaves the NICU, that parent that knows everything, who’s been part of the journey, that’s going to be the tiger parent.”

With private rooms, the new NICU creates space for the timeless element of a baby’s success: mother’s love.

Sandate’s role in the new building is to make sure patient- and family-centered care is woven into the design. “How do you create the space so that it makes parents feel like they’re part of the team?”

“My role is to bridge the gap between design and care. If I look at a meeting for design on a given floor, I make sure staff that will be taking care of patients there on a day-to-day basis have a seat at the table.”

That means UHS includes vital feedback from care providers on the ideal layout of a pediatric hospital floor.

The current pediatric floor is in the hospital’s newest tower, but it wasn’t designed for pediatrics. Its rooms are quiet and spread out, originally designed for adults. A better concept for little patients has different sightlines so that nurses can more easily keep an eye on everyone, more specific access controls, and a direct connection to a pediatric emergency department. The new hospital will have these elements, as well as being unique in how it aligns care for women and babies and children.

To integrate that care takes brainstorming with all the teams, and taking it beyond the building.

Dr. Randal Robinson, a maternal/fetal medicine specialist and chair of the department of obstetrics and gynecology at UT Health San Antonio, said expanding important prenatal screenings to the clinics is a key part of the process.

“We want to be where the patients live,” Robinson said. Then, once they come to the hospital to deliver, they’ll have support and pain-management options like tubs and midwife guidance. And since they’ll be in a state-of-the-art hospital, they’ll also have interventions available if they need them.

“If your low-risk pregnancy becomes high-risk,” Robinson said, “this is the place to be.”

The work is part of a mission that has been ongoing on all levels, resulting over the years in University Hospital achieving top designations as a regional Level I trauma center, Level 4 NICU, and Level 4 maternal care center. It’s exciting to bring those high-level operations into a new, purpose-designed facility.

But in the best of circumstances, women of childbearing age only spend a couple of days in the hospital when they have their babies. To best care for them – and to ensure those hospital stays are short – the team is working to better meet all their prevention health needs in their own communities, Sandate said. The adoption of Epic, the best electronic health record system available and already in use at UT Health, will make this easier.

“We serve a very diverse patient population,” Sandate said. “Access is key to improving outcomes.”

If you’d like to attend the groundbreaking at 10 a.m. on Saturday, Nov. 2, please register at WCH.rsvpify.com.

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