The Center provides care coordination for pregnant women who are carrying a baby with anomalies as well as for infants who have multiple anomalies or high-risk conditions. This section describes how providers can refer their patients to UNC for enrollment in these services. Services can be provided in either English or Spanish.

Prenatal Care Coordination Referrals

The main pathway for referral to the Center for pregnant women is through the Prenatal Diagnostic Unit at UNC Hospitals or Rex Hospital. Referral appointments are made by calling Lisa Welborn at (919) 843-4690 or contacting the prenatal clinic schedulers at (919) 843-6094. Providers may place a call directly to the ultrasound scheduling clinic by dialing (919) 843-6094. All referrals must include the date, the patient's name, her medical record number and her diagnosis (either preliminary or confirmed). At the time of your call, you may request to talk with the maternal fetal medicine specialist on duty. Appointments for an ultrasound and genetic counseling will be mailed to the patient.

Process

  1. When a patient receives diagnostic testing at UNC, she is also offered the opportunity to meet with a genetic counselor. Once these visits are complete, the patient will be introduced to a perinatal care coordinator (PCC). The PCC will review the services provided by the Perinatal Care Coordination program, and provide verbal and written information about the patient's condition. The PCS will address the patient's concerns and issues and assess her understanding of her baby's diagnosis and follow up steps. A personalized packet of information and resources is then given to each patient.
  2. An initial letter with the patient's prenatal diagnosis will be faxed to the referring provider to affirm that the patient has met with a PCC and has accepted our services.
  3. A treatment plan will be developed by the Center's interdisciplinary team which meets every Monday. This treatment plan with recommendations for prenatal care is faxed to the referring provider(s) upon completion.
  4. The PCS will contact the patient directly and review the treatment plan. She will schedule the needed appointments and diagnostic testing with the members of the UNC health care team.
  5. The Perinatal Care Coordinator is always available to the patient and her referring provider / clinic to answer questions about the referral process, the patient's individual treatment plan or any other concerns you may have. You can reach the coordinators by telephone at (919) 843-7863. They will assure that there is timely and ongoing communication between you and the UNC specialists.
  6. Mothers who are diagnosed as having a fetus with a condition that is likely to result in death at or soon after delivery are invited to take part in the Center's Perinatal Palliative Care Program.
  7. Most mothers complete the program at about 6 weeks postpartum. Some families with complex infants, however, are enrolled in the infant care coordination upon delivery based on the needs of their baby.

Infant Care Coordination Referrals

Infants can be enrolled into the program after meeting the medical criteria. This includes infants diagnosed with two or more congential anomalies who will require multiple, continued, subspecialty follow-up. Infants with multiple complex medical problems resulting from extreme prematurity may also be enrolled. Care coordination services may be provided to infants up to one year of age if needed. Infants who need complex, major surgeries may continue to receive care until they have passed that major milestone. The program serves both inborn and transferred infants.

Referrals to care coordination are generally made by a UNC neonatologist or a UNC pediatric sub-specialist (i.e. cardiology, critical care, genetics, nephrology, neurosurgery, surgery, and urology). The primary contact for referral of infants to the program is Lori Carter. Her office number is (919) 843-0956. She may also be reached by calling the Center's toll free number at 1-888-265-5426. Typically, care coordination services begin as the family of the infant prepares for hospital discharge.

Process

  1. When an infant is identified as meeting the program's medical criteria, a referral will be made to Lori Carter, perinatal care coordinator.
  2. The referred infant's family will be introduced to a perinatal care coordinator who will share information on the program's goals, inform the family on what to expect, and answer any immediate questions or concerns.
  3. The care coordinator will act as a resource for the family throughout the infant's hospitalization and assist families in linking into support services in their home communities.
  4. The baby's pediatric provider will receive a letter with information on the infant's diagnosis and receive care plans as the baby prepares for discharge.
  5. The care coordinator will keep the community provider informed of necessary follow-up appointments.
  6. The community provider will be contacted prior to the infant's discharge (including a potential discharge date). Communication will continue to occur should the infant be re-hospitalized.
  7. The care coordinators are always available to the referring and community providers. You can reach them by telephone at (919) 843-0956. They will assure that there is timely and ongoing communication between you and the UNC specialists.