Transforming postpartum care

When Jenny Ison gave birth to her first child, the experience was far from routine. Despite her careful preparation, her blood pressure spiked dangerously high, leading to a hospital admission for a week prior to delivery and then an emergency caesarian section. Thankfully, both she and her baby were fine, but her elevated blood pressure levels kept her in the hospital due to the associated risks. After delivery, her obstetrician recommended she take part in a program that would allow her to be closely monitored by her healthcare team in the comfort of her home.

"(The program instructions were) relatively easy,” says Jenny. “I took home the blood pressure monitoring kit, and a nurse called me to walk me through the process. I was so eager to go home and get into a routine in my life as a new mom!"

Jenny was a patient in the postpartum virtual hospital, a program piloted at the Grey Nuns Community Hospital to enable new mothers to return to the comfort of their own home as soon as safely possible while ensuring they receive top-notch remote medical care. The program was the brainchild of Dr. Christina Dolhaniuk, an obstetrician/gynecologist at the Grey Nuns, who was inspired by the success of a similar initiative at Alberta Health Services’ South Health Campus in Calgary.

Christina believed that the stress of the hospital environment could contribute to elevated blood pressure levels in new moms, and the program in Calgary had demonstrated how remote blood pressure monitoring could facilitate a quicker and more comfortable return home for patients. In the fall of 2021, the Grey Nuns reached out to partner with the AHS Edmonton Zone Virtual Home Hospital (EZVHH) that, since 2018, has provided acute hospital-level care at home to a variety of patient populations. A team from the Grey Nuns, EZVHH, Health Beginnings and Community Paramedics collaboratively came together to co-design the virtual hospital postpartum hypertension pathway.

The pilot launched in November of 2022 and concluded in January of 2023, but the program has been continuing at the Grey Nuns since then. To be eligible, new moms need to be low risk, with high blood pressure that can be managed remotely. The patients are given a blood pressure monitoring kit and are shown how to take their blood pressure at home daily. They are also given an iPad with software preinstalled so they can speak to a nurse while they take their blood pressure and ask any questions.

“The virtual hospital is sanctioned by Alberta Health Services, so all the nurses are AHS nurses,” says Heidi DeLange, program manager for women’s and child health at the Grey Nuns. “The program runs similarly to a hospital without the patient needing to be in the hospital.”

In cases where the blood pressure reading is concerning, the nurse will assist the patient remotely, says Heidi. In serious cases, the nurse will send a paramedic to admit the patient to hospital.

“Our patient feedback has been overwhelmingly positive. Many patients feel like they are prepared and very supported by the nurses and the process. They enjoy being comfortable at home, and they enjoy the independence. They express gratitude at being able to be home with their baby and reassured that they are still being monitored.”

For Jenny, feeling supported has been an important part of the experience. “One of the best things about the program is knowing that the nurses and doctors are there to reassure me,” she says.

“I know I don’t have to rush to emergency and wait there for several hours with a newborn to make sure things are normal. I can wait because I know I have a nurse checking in on me every day.”

Along with providing comfort for patients, the program has resulted in less stress on resources at the hospital, says Christina. A study she and her team conducted during the pilot found that acute care hospital visits for new moms dramatically decreased: only six patients in the virtual hospital group returned to the hospital, while 26 patients in a control group of new moms returned.

“Based on the data we collected, 100 per cent of patients would recommend this program to friends and family. Patient satisfaction is higher, patients feel that their quality of care was better (being able to be comfortable at home) and I believe the patients are happier.”

Christina hopes that the success of the Grey Nuns pilot will lead to use of a virtual hospital approach in other areas of acute care.

“The biggest question we need to ask is, How can we be innovative and think outside the box to try to decrease the pressure on the healthcare system?” she says. “I think this program has shown we can do that. Our first step is to try to expand the program to all postpartum units across the Edmonton Zone and see where we can expand into other units next.

“I personally believe that a lot of health care will end up being virtual or a combination of virtual and in person in the near future.”

Given her firsthand experience with virtual care, Jenny echoes this hope.

“My story has been amazing,” she says. “I’ve recommended this program to my friends who are pregnant right now, if they need it. I’m really excited for the future of this program, and I’m hoping this might be the future (of health care).”