Greater Toronto area-obstetrical
The GTA-OBS Network, created in October of 2013, is a collective network of Obstetricians
The Obstetrics community across the Greater Toronto Area spans a group of teaching and
The intention of the GTA-OBS Network is to collaborate in unprecedented ways to collect and
Originally called “TAHSN-OB,” the current name “GTA-OBS Network” has evolved to
Read the 2016 Winter GTA-OBS Network newsletter!
I am delighted to write the first welcome note for our new webpage. As you search through the content, you'll find contained therein our vision, terms of reference and, most exciting for us, a list of network activities that have already commenced. I am also delighted to say that almost all of our members have paid their dues and are thus listed as active members. I am sure that the rest will follow suit as activities of our GTA-OBS Network take full swing!
We have decided to publish the minutes of the monthly executive meetings, found under the “Network Structure” tab, so that all members of the website can be kept up-to-date, and, of course, feel free to contact me at any time should these minutes prompt an idea or a point for discussion.
Some of the important work of our Network is information-gathering and you'll note that two or three surveys have already come across your desk from the Network. This information will be vital to plan out for the quality assurance initiatives and studies so please complete them to aid us in our efforts of improving health care and patient safety across Ontario, with far-reaching implications.
Much appreciation goes out to Dr. John Kingdom, the Chair of Obstetrics and Gynaecology at the University of Toronto, for his support and agreement to host this webpage as part of the University of Toronto.
As we pursue with the development of projects and moving our objectives forward, please feel free to contact me if you have any ideas, suggestions, or concerns.
With best wishes,
The vision of the GTA-OBS Network is to become an international leader in research, best practice and advocacy in women’s and infants’ health by leveraging the power inherent in a GTA-wide collaborative approach.
The goals of the GTA-OBS Network are the following:
- To improve quality and standards of care: we will create and implement shared standards and guidelines to improve patient-centred quality of care and, ultimately, the longitudinal health of women and babies across the region with important world-wide implications;
- To conduct collaborative, multi-site clinical research: we will design and conduct novel randomized controlled studies as well as studies that will leverage existing databases such as BORN, ICES, CNN;
- To develop a shared advocacy: we will advocate on behalf of women and babies in Ontario to influence policy here and worldwide;
- To promote knowledge sharing: we will foster professional and practice development among all members.
The GTA-OBS Network has selected an Executive Committee, who will take the responsibility of suggesting research questions, fostering collaboration, promoting membership, and tracking success and progress. The Executive will also be responsible for creating sub-groups which will take shared responsibility to ensure successful completion of projects in a timely manner. The full Network will meet twice a year, while the executive committee and the sub-committees will meet regularly.
For full Network meetings, members will share accountability for hosting and coordinating regular meetings, based on a rotating schedule developed at the beginning of each year. The host of each session will be responsible for disseminating invitations, setting the meeting agenda, ensuring participants are briefed to be able to address the topic areas for that meeting, and creating summary notes.
Executive Committee Members
- Jon Barrett – Chair
- Elizabeth Asztalos - Neonatal Representative (Sunnybrook Health Sciences Centre)
- Howard Berger – Teaching Hospital Representative (St. Michael’s Hospital)
- Adrian Brown – Community Hospital Representative (North York General Hospital)
- Michael Geary - Lead for Obstetrics on Quality & Safety Committee (University of Toronto)
- Ronald Heslegrave - Ethics Advisor (Mount Sinai Hospital)
- Terry Logaridis – Community Hospital Representative (Rogue Valley)
- Peter Scheufler – Community Hospital Representative (Trillium Health Partners)
- Gareth Seaward – University of Toronto Representative & Vice-Chair of Quality Improvement and Patient Safety
- Anne Sprague, Better Outcome Registry and Network (BORN) Liason & Research Coordinator
The Network will be responsible for:
- Organizing structured meetings for collective discussion of questions pertinent to high quality practice of obstetrics to improve practice, develop shared guidelines and spark research collaborations;
- Organizing stronger connections between obstetricians practicing in academic and community hospitals to advance practices and processes, with the goal of improving quality and seamlessness of care;
- Identifying quality and outcome improvement measurements and setting of targets which the Obstetrics community will aim to achieve;
- Creating opportunities for all members (academic and community hospitals) to participate as equals;
- Developing useful guidelines to improve standards of patient care across the GTA;
- Developing a robust, connected research and data collection platform.
Scope of authority
The GTA-OBS Network is a voluntary association of specialists for the purpose of shared learning, developing collective insight, advocacy and developing opportunities for collaborative research. The Network has no formal authority over its members or any of their affiliated institutions. Guidelines developed by the Network are advisory, not binding. Membership is at will, and members may withdraw from the network at any time, however, membership reimbursements will not be given.
The GTA-OBS dashboard is comprised of specific quality of care indicators that were chosen by member hospitals as important indicators of quality of care. These indicators are not meant to override the importance of the Provincial dashboards, but perhaps to enhance them and provide quality of care indicators that Network members feel are appropriate in this particular region.
It is important to realize that any dashboard of quality of care, despite its name, may in fact not reflect the actual quality of care delivered in any specific case or in any individual hospital. There are many variables, for example, that can affect the admission of a term infant to the NICU, some of which might have to do with health policy or management in a particular hospital rather than the quality of care imparted to the woman or her infant. We see this dashboard as the beginning, or first look, at what is happening to our patient with respect to important outcomes in the GTA. They will serve as the starting point for a closer look in certain areas, such as the GTA-OBS initiative on postpartum hemorrhage reduction, for example.
In many instances, it is difficult to look at a quality-of-care indicator without considering what we are ultimately trying to achieve - a healthy outcome for mother and baby. For example, we still do not know what the optimal Cesarean section rate should be to provide optimal outcomes in 2015.
However, the dashboard does provide partner hospitals with a bird’s eye glance of comparative hospitals and comparative outcomes which we hope will be the driving force behind quality improvement projects.
A disclaimer: some of the data in the BORN database may not have been validated and further work is in process in this area. Nevertheless, we feel it is an important start and further dashboard updates will allow hospitals to embark upon projects themselves or as part of the Network.
You will see that hospitals are anonymized and the identity of each is only known to BORN and each individual hospital. It will stay that way unless all partner hospitals get permission for this data to be de-anonymized. We think the time has passed in which physicians practice without outcomes - we should embrace the opportunity to work together towards transparency and the improvement of the quality of care of our patients.
The 2016 Winter GTA-OBS Newsletter is now here! Click here to view it!
There is no national consensus on the optimal screening strategy and diagnostic thresholds for Gestational Diabetes. In order to ensure that all our network centres are using a uniform approach that will facilitate research and quality initiatives we have endorsed the following strategy which aligns with the CDA 2013 preferred approach.
- Invasive Placentation Delphi Survey
- Management of Short Cervix and Previous Preterm Birth
- Post Partum Hemorrhage Bundle
- Common In Utero Transfer Note
- Routine Cervical Screening Protocol
Membership may include hospitals/health science centers, educational institutions and organizations with mandates which are directly related to data collection, research or practice of obstetrics in the GTA.
The following sites have joined the GTA-OBS Network:
- Mount Sinai Hospital
- North York General Hospital
- Rouge Valley Health System - Ajax and Pickering Site
- Rouge Valley Health System - Centenary Site
- Royal Victoria Regional Health Centre
- The Scarborough Hospital - Birchmount Campus
- The Scarborough Hospital - General Campus
- Southlake Regional Health Centre
- St. Joseph's Health Centre Toronto
- St. Michael's Hospital
- Sunnybrook Health Sciences Centre
- Toronto East General Hospital
- Trillium Health Partners - Credit Valley Hospital
- Trillium Health Partners - Mississauga Hospital
- William Osler Health Centre - Brampton Civic
- William Osler Health Centre - Etobicoke General Hospital
- Halton Healthcare Services - Milton District Hospital
- Mackenzie Health – Richmond Hill
How to become a partner
The Network always welcomes new partners. Joining the Network is the right choice for you if you are looking to:
- Participate in fruitful discussions which will lead to impactful changes in patient care, safety, and advocacy for women’s health;
- Contribute to the design of a new guideline improving quality and delivery of care;
- Design and lead a cohort study or a randomized controlled trial within your centre or even across multiple research sites in the GTA!
During the first 2 years of the Network’s existence, the membership fees for academic and community hospitals are $5,000/year and $3,000/year, respectively. In the absence of any funding following the first 2 years of Network existence, the membership fees will be $10,000/year and $5,000/year for academic and community hospitals, respectively.
As I am sure you are well aware, immunization during pregnancy is becoming more common and some vaccines are now recommended for pregnant women. In this context, Dr. Eve Dube is conducting a study to assess the opinions of Canadian maternity healthcare providers regarding vaccination during pregnancy. This study is being conducted by the Canadian Immunization Research Network with funding from the Canadian Institutes of Health Research and the Public Health Agency of Canada.
It would be great for the GTA-OBS Network to participate in this important project. Participation entails an individual telephone interview for a maximum of 25 minutes (scheduled at your convenience).
We encourage you to complete the survey yourself and share with your colleagues practicing in maternity care (ob-gyn, family physicians, nurses, midwives). If you are interested in participating, please provide your contact information in this short form, http://fluidsurveys.com/s/vaccination_during_pregnancy/, and Dr. Dube will be in touch with you shortly.
This study is being done by the Canadian Immunization Research Network with funding from the Canadian Institutes of Health Research and the Public Health Agency of Canada. The Ethics Review Board of the CHU de Québec – Université Laval has approved the protocol of this study.
For more information, please contact Mrs. Dominique Gagnon, research coordinator, at 1-418-666-7000, extension 311, or by email at Dominique.email@example.com.
Chair, GTA-OBS Network
M.B.Bch., FRCOG, MD, FRCSC
Associate Scientist, Sunnybrook Health Sciences Centre
Women and Babies Program
Department of Evaluative Clinical Sciences, Sunnybrook Research Institute