Interdisciplinary Team: The Level IV OB Center must have an interdisciplinary

Interdisciplinary Team: The Level IV OB Center must have an interdisciplinary team that includes individuals with expertise in and/or knowledge about the specialized care, treatment and services required for perinatal care. The interdisciplinary team includes individuals and specialized services to support the care, treatment, and services provided by the program. The following individuals and services are represented on the team: 1. Obstetrics and Gynecology physician: The Obstetrics and Gynecology physician with obstetrics training and experience must be available for consultation at all times. 2. Obstetrics: A board-eligible or board-certified obstetrician must be physically present on site at all times. 3. Qualified Physicians/Certified Nurse Midwife: Ensure that a qualified physician or certified nurse midwife with appropriate physician back-up is available to attend all deliveries or other obstetrical emergencies. a. Must arrive at the patient’s bedside within thirty (30) minutes of an urgent request; and b. Must complete annual continuing education, specific to the care of pregnant and postpartum patient, including complicated conditions. 4. Maternal-Fetal Medicine (MFM): A board-certified MFM attending with full inpatient privileges must be readily available at all times, either on site, by phone, or by telemedicine for consultation and management. The need to be on site is directed by the urgency of the clinical situation; however, the provider must be able to be on site to provide direct care within 24 hours. The MFM specialist shall also be available at all times for consultation for all pregnant or postpartum patients in the ICU. 5. MFM Critical Care Team: The facility must have a MFM critical care team in place whose members have the expertise to manage highly complex, critically ill, or unstable maternal patients. This includes co-management for all pregnant or postpartum patients in the ICU. a. A MFM Critical Care Team member with full obstetrical privileges shall be available at all times for on-site consultation and management, and to arrive at the patient’s bedside within thirty (30) minutes of an urgent request b. A board-certified MFM physician with expertise in critical care obstetrics shall lead the team. 6. Anesthesia: Board-certified anesthesiologist with obstetric anesthesia fellowship training or experience must be physically present on site 24 hours a day, 7 days a week. 7. Medical/Surgical: On-site medical and surgical capabilities must be available for complex maternal conditions. 8. Intensive Care Unit: There must be the availability of an on-site adult medical and surgical ICU for obstetric patients who are primarily or co-managed by an MFM team. This includes the onsite provision of medical and surgical care for complex maternal and surgical care for complex maternal conditions, supported by the availability of critical care units or ICU beds. (Co- management includes at least daily rounds by an MFM specialist physician with interaction with the ICU team and other subspecialists with daily documentation.) The ICU must be staffed by adult critical care providers on site 24 hours a day, 7 days a week. In some settings, the ICU is in adjoining or connected building, which is acceptable as long as maternal-fetal medicine care is as noted above. If the woman must be transported by ambulance to the ICU, this is not considered onsite. 9. Internal medicine providers, family medicine providers, and general surgeons must be readily available at all times for obstetric patients. 10. At least one of the following adult subspecialties must be readily available for consultation and treatment as needed onsite: neurosurgery, cardiac surgery, or transplant. If the facility does not have all three subspecialties available, there should be a process in place to transfer women to a facility that can provide the needed services. 11. Nursing: The center shall have a continuous availability of adequate RNs who have experience in the care of women with complex medical illnesses and obstetric complications with close collaboration between critical care nurses and obstetric nurses with expertise in care for critically ill women. i. The Nursing Service Line leadership must have an advanced degree and national certification. 12. Laboratory and Blood Bank Services: Laboratory personnel must be immediately available to obtain and process appropriate samples and report urgent/emergent results. Blood bank services must be available at all times to determine blood type and Rh type, crossmatch blood and perform antibody testing. There must be in-house availability of all blood components. There must also be guidelines or protocols in place for: a. Massive blood component transfusion; b. Emergency release of blood components; and c. Management of multiple blood component therapy. 13. Radiology Support: Radiologic services with interpretation must be readily available at all times and include: a. Specialized obstetric ultrasound and fetal assessment (to include Doppler studies); b. Computed tomography scans; c. Magnetic resonance imaging; d. Standard obstetric ultrasound imaging; e. Maternal echocardiography; and f. Advanced interventional radiology (capable of performing uterine artery embolization). 11. Respiratory and Pharmacy: Respiratory care personnel and a registered pharmacist should be readily available at all times. 12. Support Staff: a. Lactation Specialists: Lactation Specialists or support staff with knowledge and skills in breastfeeding and lactation to meet the needs of maternal patients must be available at all times. b. Social services, pastoral care, or bereavement services must be provided as appropriate to meet the needs of the patient population served. c. A dietician or nutritionist should be available with the appropriate training and experience for the population served. 13. Subspecialists shall be readily available, per the facility’s policy, for inpatient consultation, which includes critical care, general surgery, infectious disease, hematology, cardiology, nephrology, neurology, gastroenterology, internal medicine, behavioral health, and neonatology. a. At least one of the following adult subspecialties must be available at all times, per the facility’s policy, for consultation and treatment needed on site: i. Neurosurgery ii. Cardiac surgery iii. Transplant surgery Note: If the organization does not have all three subspecialties available, there should be a process in place to transfer women to a facility that can provide the needed services.