Non-stress tests (NSTs) are the current standard of care for monitoring high-risk pregnancies. Intended to reduce the risk of stillbirths, these tests are for those who have one or more risk factors, whether they be maternal, fetal or obstetric complications.
Currently, these tests can be very time-consuming for patients. NSTs involve attaching the mother to fetal and contraction monitors to watch the fetal heart rate tracing and uterine activity. However, many rural and remote areas don’t have ready access to NSTs. Consequently, mothers sometimes travel up to several hours each way to get to our facility for their NST appointments once or twice a week. Once they arrive, there’s the usual wait time, the 30-60 minute testing process, plus an additional wait time for the test to be interpreted by a staff member and a clinician. These appointments, on top of any additional prenatal visits the mothers have scheduled, can therefore add up to a considerable amount of time, even for patients who live nearby.
Telehealth and at-home NSTs may be able to transform this process for our patients. We are now conducting a pilot study that provides patients the technology to conduct at-home NSTs. Mothers in their third trimester of pregnancy who are on a schedule of twice-weekly NSTs will have one test on-site and one test at home every week. These patients will be thoroughly trained on how to use the at-home NST device, and will conduct a practice NST in the presence of an advanced practice clinician before sending them home to do the testing. After that, patients will conduct the home NSTs themselves as part of a ‘virtual’ appointment, with an advanced practice clinician carefully monitoring the test results.
By conducting NST tests at home, we hope the following might be achieved:
- Improved Patient Satisfaction: A telehealth strategy for NSTs will reduce the number of required on-site appointments. This strategy also means more flexibility, comfort and convenience for our patients.
- Enhanced Efficiency and Capacity: Facilities have a limited amount of space and personnel to conduct NSTs. For example, the University of Utah Health Care has four chairs dedicated to these tests, so appointments need to be scheduled accordingly. By conducting NSTs at home, we can engage with more patients, increasing our flexibility to accommodate those who need NSTs. While there still needs to be careful supervision by trained clinicians, this process may greatly improve our efficiency and capacity for NST testing.
- Cost Effectiveness: Performing an NST can cost several hundred dollars, and part of that fee is for the use of the facility. The clinician interpretation portion of the billing is always going to be the same – someone always has to look at the results and render an opinion – but by conducting a number of these tests off-site, there is an opportunity for significant cost savings for payors. Home NSTs may also mean cost savings for the hospital, since efficiency and capacity are expected to improve. Patients will also likely save money related to travel, missed work and childcare expenses.
Healthcare systems are becoming increasingly interested in implementing innovative care strategies in order to improve the quality of health care, reduce cost and improve patient satisfaction – in other words, create value. Within obstetrics, home NSTs show promise for helping to achieve these aims. Our research will consider whether this technology could develop into a viable NST option for health care systems across the nation.
Erin Clark, MD has been an Assistant Professor of Obstetrics and Gynecology at the University of Utah Health Sciences Center since she completed her Maternal-Fetal Medicine Fellowship at the University of Utah in 2009. She is board certified in Obstetrics and Gynecology, as well as the subspecialty of Maternal-Fetal Medicine. She initiated the Preterm Birth Prevention Clinic for the Utah Department of Health in 2010. Dr. Clark’s current research includes a grant from the NICHD to look at markers of developmental delay and cerebral palsy. Other interests include pelvic floor dysfunction related to childbirth and preterm labor.