Dr. John Schorge and his team in the Regional One Health OB/GYN Service are committed to addressing health care disparities in our community.
They recently embarked on two successful initiatives to improve care for conditions that disproportionately impact Black women.
Thanks to their efforts, more expectant moms are getting prompt care for preeclampsia and more women have access to minimally invasive hysterectomies.
When Dr. John Schorge came to Regional One Health in 2022 to lead the OB/GYN service, one of his goals was to improve outcomes for Black women by closing the gap on health care disparities in the Mid-South.
Now, two initiatives show significant, sustainable success: Regional One Health is among the best hospitals in the state for rates of prompt treatment for preeclampsia (severe hypertension during pregnancy) and minimally invasive hysterectomy.
Dr. Schorge said Black women are at higher risk for preeclampsia and large fibroids requiring a hysterectomy, so making progress on these conditions was an immediate priority.
“Our OB/GYN Department is committed to excellence because the women in our community deserve the very best,” said Dr. Schorge, a complex gynecologic surgeon and gynecologic oncologist. “We want to provide the same level of care for our patients as we would insist upon for our own family members.”
Prompt care for preeclampsia
To address preeclampsia, they joined 14 other hospitals in a two-year project led by Tennessee Initiative for Perinatal Quality Care (TIPQC), a statewide organization devoted to improving pregnancy, childbirth and the postpartum care. TIPQC set a goal of treating high blood pressures of preeclampsia within 60 minutes of diagnosis.
“Black women have a maternal mortality rate 3 to 4 times higher than that of White women, and one reason is they have a higher likelihood of preeclampsia,” Dr. Schorge noted. “For too many patients, it goes undiagnosed, and delays in care lead to bad outcomes. We are the location in the state with the most patients with this condition, so it’s a high priority for us.”
Dr. Schorge assembled a team that understood and embraced the need for prompt treatment.
Dr. John Schorge, who leads Regional One Health’s OB/GYN service, is helping women have better access to prompt care for preeclampsia and to minimally invasive surgery for hysterectomy.
The group, led by maternal fetal medicine specialist Dr. Kerri Brackney, included Lilly Cooper, nursing administration director; Lauren Russell, nursing manager for labor & delivery; Bonnie Miller, clinical nurse specialist for professional development; Annette Hickerson, clinical research coordinator; and OB/GYN resident Rachel Nelson.
They brought in the necessary resources and empowered labor & delivery nurses to advocate for immediate care for patients with preeclampsia. Ultimately, they achieved a rate of 96 percent of patients receiving care within the one-hour benchmark.
“We’re now at the top score level in the state, even as we have two-thirds of the patients in the project,” Dr. Schorge said. “These remarkable results ensure moms are treated promptly for a dangerous condition. Early treatment can prevent stroke, heart damage and kidney disease, all of which have major long-term health consequences.”
Dr. Schorge encourages women to seek early prenatal care and immediately see a doctor if they are pregnant and develop high blood pressure.
Black women, women with chronic hypertension, and women who are pregnant with multiples are at higher risk for the condition. Symptoms include a severe headache that won’t go away, vision changes, nausea, dizziness, and swelling in the legs, hands or face.
“Listen to your body,” Dr. Schorge said. “If you’re experiencing severe headaches or problems that just don’t feel right for you, we need to get you in, the sooner the better.”
Raising rates of minimally invasive hysterectomy
Dr. Schorge is also striving to ensure access to minimally invasive surgery for women who need a hysterectomy, often due to uterine fibroids.
“Black women in this country have a much lower rate of minimally invasive hysterectomies despite a number of benefits,” Dr. Schorge said. “You go home the same day, there’s lower risk of infection, less need for pain medication, fewer blood clots, and you go back to work sooner.”
Dr. Schorge’s team is participating in a state project to ensure women who are diagnosed with preeclampsia receive treatment within 60 minutes. Their work has made Regional One Health a state leader in meeting that benchmark.
Nationally, 70-75 percent of White women have minimally invasive hysterectomies, while the rate for Black women is about 50 percent with double the risk of complications. The OB/GYN team took several steps to remedy this disparity at Regional One Health.
A surgery team led by Dr. Linda Moses and Dr. Florene Odulana worked to expand the percentage of patients eligible for vaginal hysterectomy. “This is the ultimate minimally invasive procedure, because there are no abdominal incisions,” Dr. Schorge said. ‘The American College of Obstetricians and Gynecologists recommends this as the preferred route of hysterectomy.”
Additionally, Regional One Health invested in the gynecology service line by providing state-of-the-art tools and equipment to facilitate complex laparoscopy thanks to the efforts of Jill Collier, Vice President for Perioperative Services; Sharon Morris, Nursing Manager for Surgical Services; and Cheryl Bradshaw, Nursing Manager for Surgical Services.
As a result, the OB/GYN faculty as a group and resident assistants were able to expand their ability to safely perform minimally invasive hysterectomy for larger uteri.
Finally, there are occasions when unexpected findings necessitate converting to open hysterectomy. Fortunately, when this happens now, the OB/GYN faculty can consult Dr. Schorge and usually complete the operation laparoscopically instead. “It’s a win-win for our doctors but more importantly for our patients,” Dr. Schorge said.
Dr. Schorge is also educating patients to be aware of signs of fibroids so they can make sure there is nothing more serious, like uterine cancer, and to counsel them about minimally invasive surgery if they end up needing an operation. The classic signs of these conditions are abnormal vaginal bleeding and pelvic pain.
Already, the results of the team’s efforts have been striking.
In 2023, Regional One Health’s rate of minimally invasive hysterectomy was 91 percent, and in January 2024, it was 100 percent. Because the OB/GYN surgeons and resident assistants are gaining experience with minimally invasive surgery for larger uteri, the results are sustainable, Dr. Schorge said.
Thanks to these efforts, he noted, women are receiving top-level minimally invasive procedures at Regional One Health that offer quicker recovery times, improved outcomes and overall better health.