In This Section
Comprehensive Placenta Accreta Care Program Achieves Superior Outcomes
Duke Health, Abridge Partner to Improve Clinician Efficiency and Patient Care
Accuracy. Efficiency. Transparency. Trust. RFID Technology Helps Offer Patients Peace of Mind.
Comprehensive Placenta Accreta Care Program Achieves Superior Outcomes
By Nicole Jablonski, Duke Health Clinical Practice Today
Jennifer Gilner, MD, PhD, maternal-fetal medicine specialist, has led Duke’s Placenta Accreta Care Program since 2016. Today, it’s the most comprehensive program of its kind in North Carolina. The multidisciplinary team’s evidence-based screening and treatment protocols have fostered a destination program with superior patient outcomes.
“Getting an accurate placenta accreta spectrum (PAS) diagnosis as early as possible allows us to risk-stratify the patient and create a customized care plan that reduces serious risks to mother and baby at the time of delivery,” said Dr. Gilner.
Risk Factors and Screening
Nationally, between 40 and 50% of accreta spectrum cases are not suspected, which leads to more bleeding and other complications at delivery. “The greatest opportunity for impact is recognizing patients’ risk factors and referring for screening with specialized imaging by 26 weeks. Patients have significantly better outcomes if we monitor them and plan ahead,” said Dr. Gilner.
Major risk factors for developing an abnormal relationship between the uterine lining and the placenta include:
- Having placenta growth near a prior uterine scar, most commonly from a prior cesarean
- Any placenta growth in an abnormal location (e.g., previa) or near an area of prior uterine procedure (e.g., cesarean, hysteroscopy or D&C)
“If patients’ first or second trimester routine ultrasounds reveals a placenta low in the uterus, or near or covering the cervix, and they’ve had prior uterine surgeries, we strongly recommend referring to us for a consultative ultrasound,” said Dr. Gilner.
It’s widely published that delivery at a prepared center with an experienced team improves outcomes. We routinely get referrals from Georgia, Virginia, all over North Carolina and states even farther away.”
—Jennifer Gilner, MD, PhD
Dr. Gilner helped develop an evidence-based protocol for diagnostic ultrasounds at Duke. “This ultrasound takes more time; it captures images and specialized views that wouldn’t be part of a standard anatomy ultrasound,” said Dr. Gilner.
Superior Outcomes
Duke’s Placenta Accreta Care Program achieves lower severe maternal morbidity rates compared to national averages, including blood loss and likelihood of transfusion. The national rate for hemorrhage that requires transfusion is 46.9%, while Duke’s published rate of transfusion for scheduled delivery cases is 14.8%. Considering that 30 to 40% of patients with accreta require urgent or unscheduled delivery prior to their intended delivery date, it’s important for care teams to have standardized systems and mobilize quickly. “Our specialists are available 24/7.”
References:
American Journal of Obstetrics and Gynecology (9.2019)
Best Practice & Research Clinical Obstetrics & Gynaecology (4.2021)
When To Refer for PAS Screening
Clinical Risk Factors
- Placenta previa with a history of uterine surgery, such as a cesarean or D&C
- Persistent 26-30 week placenta previa, low-lying placenta or any placental tissue overlying prior uterine scar
- Placenta overlying other site of intrauterine surgery
- Prior clinical suspicion of focal accreta or history of Asherman’s
Ultrasound Findings
- Gestational sac located low in the uterus in the first trimester (particularly with prior uterine surgery)
- Placenta previa with prior uterine surgery
- Mid-trimester low-lying placenta with prior history of cesarean
- Mid-trimester placenta with significant lacunae, particularly within the maternal side of the placenta
Referral to Duke’s Placenta Accreta Care Program: 919-613-6863.
Duke Health, Abridge Partner to Improve Clinician Efficiency and Patient Care
By Sarah Avery, Duke Health News & Media
Duke Health and Abridge, a developer of generative AI for clinical conversations, have established a strategic partnership to collaboratively explore new health care artificial intelligence (AI) innovations.
As a component of this partnership, Duke Health has implemented Abridge’s AI-powered clinical documentation platform to key clinical teams. The Abridge real-time ambient AI platform will be available to 5,000 Duke Health clinicians at more than 150 primary and specialty clinics.
The platform will be used throughout Duke Health Integrated Practice and Duke Primary Care clinics, which serve communities in the Triangle and other locations in North Carolina. It will enable clinicians to integrate notes into patients’ medical records during visits, enhancing the experience for both patients and providers.
“Duke Health is one of the most innovative and forward-thinking health care systems,” said Shiv Rao, MD, founder and CEO of Abridge. “This collaboration will accelerate our innovations to power deeper understanding in health care by unlocking the value in clinical conversations across additional use cases.”
Abridge’s technology assists in the note taking process by providing AI-generated documentation of the conversation between patient and clinician during the appointment. Clinicians review the notes and can edit them before they are integrated into the patient record.
The AI platform is designed to help alleviate burnout by reducing the time clinicians spend on documentation. More than 50% of physicians surveyed by the American Medical Association reported feeling a great deal of stress in their jobs, with more than 12% citing too many administrative tasks.
As a leading academic medical center, the drive to improve patient care is part of Duke Health’s DNA. With this platform at our disposal, our clinicians are able to focus more fully on patients and less on documentation, restoring what the patient-clinician relationship is supposed to be about. Their time together will be more productive, more satisfying and more human.
—Matthew D. Barber, MD, MHS
In addition to implementing the clinical notes platform, Duke is exploring opportunities with Abridge to co-develop other clinical applications that use ambient AI.
“Duke Health is furthering its legacy of innovation and AI leadership through this new partnership with Abridge,” said Jeffrey Ferranti, MD, senior vice president and chief digital officer of Duke University Health System. “Our clinical expertise partnered with Abridge’s AI capabilities will lead to some truly impactful AI solutions. AI documentation will undoubtedly enhance clinician-patient interactions, but it is only the beginning of what this partnership can achieve.”
Reference: duke.is/AMABurnoutRate
Early Adopters
Ob/gyns explain how embracing Abridge AI Scribe has ‘bridged the gap’ in time management and efficiency
Pictured, left to right:
Clayton Alfonso, MD | Generalist
Amie Kawasaki, MD | Urogynecologist
Alejandro Landa, MD | Generalist
Nazema Siddiqui, MD, MHSc | Urogynecologist
In the fall of 2024, Duke Ob/Gyn was among the first departments in the Duke University Health System to begin using Abridge’s AI Scribe. The goals: to improve the experience of both providers and patients by reducing the documentation burden and allowing clinicians more time of focus on patients.
Q: What was the adoption process? How easy was it to begin using?
Dr. Kawasaki: I attended one general training session — a 30-minute presentation covering how to use the software and how to prepare my notes to receive the information. Because of my personal interest in technology, I also attended one of the “drop-in” sessions where an Abridge representative was fielding questions. I found it to be very intuitive and using this has integrated easily into my workflow.
Dr. Alfonso: The software is very straightforward to use and only required me to remember to bring my phone into the clinical encounters, which was new for me. I had to adapt to speaking the physical exam out loud to allow for the software to know what to document.
What were the challenges?
Dr. Siddiqui: The biggest challenge was the mental commitment to just start using it, and the few small changes in workflow. I did not set aside a lot of time to learn, and at first, I thought that would be a barrier — but it really wasn’t. Moving forward, my biggest challenge will be how to integrate this technology when I also have learners in the clinic with me (usually they write the notes).
How has Abridge AI Scribe impacted your workflow?
Dr. Siddiqui: It has affected me in two ways. It has reduced the time I spend after clinic documenting on patient encounters. This is especially true for complex patients, those with a lot of data from outside our electronic medical record upon arrival (tests, imaging, etc.) and complicated return visits. These visit types are not as easy to enter into our templated notes. AI Scribe helps particularly well with summarizing the history of present illness, and also summarizing test results when I’m reading outside records (so I don’t have to type them). Additionally, the after-visit summary information is amazing! It summarizes in really patient-friendly language with distinct instructions for the patient.
Dr. Landa: Abridge definitely has allowed me to concentrate much more on the patient communication and information gathering. I’m able to be more patient and interrupt less. I’m able to listen more without worrying about visit times. It has allowed me to complete all the documentation in the same day, without staying late. I think the quality of the notes is better overall.
How do you feel it has affected your clinical stresses or ability to spend more time with patients?
Dr. Kawasaki: This has been instrumental to leading to timely closure of my notes and my patients are getting more detailed information that is personalized. Not only that, but I am free to converse with my patients and provide recommendations while looking at them and their family members in the eyes. This has improved my connection with patients.
Dr. Siddiqui: I didn’t realize before how much mental energy it took when I was multitasking (listening to patients, trying to make periodic eye-to-eye contact and writing notes all at the same time). Previously, I don’t think I realized the mental “tax” as it was happening. The biggest difference I noticed was that I was really able to focus on the patient. This felt very freeing.
Dr. Alfonso: It has decreased stress overall. I feel less rushed to leave the patient room — thus spending more time with the patients, which I think patients will like overall.
How has your overall well-being been affected?
Dr. Kawasaki: I feel less stressed about completing notes in a timely manner, and my pace has become less frenzied. I’m still busy — just not chaotic.
Dr. Landa: I definitely can tell that decreasing stress and worries about finishing notes on time has some impact on burnout. Notes and documentation are only a portion of physician burnout, but this definitely helps to cope with it and decrease it.
How do you see it impacting education and how trainees are prepared as they enter the workforce as clinicians?
Dr. Landa: I think that it allows me to spend more time talking to students and learners. I think that students and learners should still be able to formulate notes, and we can integrate this technology into it.
Accuracy. Efficiency. Transparency. Trust. RFID Technology Helps Offer Patients Peace of Mind
At Duke Fertility Center, the integration of the RI Witness platform marks a significant advancement in the safety and efficiency of fertility treatments. This state-of-the-art technology utilizes radiofrequency identification (RFID) to ensure the highest standards of care.
Enhanced Safety and Accuracy
Sample Identification and Tracking:
RFID Technology: Each patient’s samples are tagged with unique RFID chips, allowing for real-time tracking throughout the laboratory process.
Error Prevention: The system automatically alerts staff to any mismatches or potential errors, ensuring that only the correct samples are used.
Comprehensive Monitoring:
Continuous Oversight: The RI Witness system continuously monitors the handling and movement of samples, reducing the risk of human error.
Audit Trail: The platform creates a detailed audit trail for each sample, documenting every step from collection to transfer.
Improved Efficiency
Streamlined Processes:
Automated Tracking: The automated nature of the RI Witness platform reduces the need for manual checks and documentation, allowing laboratory staff to focus more on patient care.
Time-Saving: By minimizing the potential for errors and streamlining verification processes, the platform enhances overall laboratory efficiency.
Simplified Workflow:
Integrated System: The RI Witness platform integrates seamlessly with existing laboratory workflows, making it easy for staff to adopt and utilize.
User-Friendly Interface: The platform’s intuitive interface simplifies the process of monitoring and tracking samples, ensuring that staff can quickly and accurately manage their tasks.
Increased Transparency and Trust
Patient Confidence:
Peace of Mind: Patients can be assured that their samples are being monitored with advanced technology, providing them with greater peace of mind during their treatment.
Clear Communication: The detailed records and audit trails generated by the platform allow for clear and transparent communication with patients regarding the handling of their samples.
Detailed Reporting:
Comprehensive Reports: The RI Witness platform generates detailed reports on the status and handling of each sample, which can be shared with patients to build trust and transparency.
Regulatory Compliance: The platform helps ensure compliance with regulatory standards, providing additional reassurance to patients and stakeholders.