2017 Innovation Awards Winner – UTHSC O B F.A.S.T.

Innovation: OB F.A.S.T., (Obstetrical Feasible Approach to Safety Training), an innovative simulation program to train healthcare workers to efficiently handle obstetrical emergencies.

Shelby county has received national media attention for one of its most heartbreaking challenges — having one of the nation’s highest mortality rates, particularly among black infants. But last year, the Shelby County Health Department announced it had reached a historic milestone in decreasing infant mortality rates.

Data showed that in 2015 the rate of infant deaths among non-Hispanic blacks was reduced by nearly half, from a rate of 21.0 in 2003 down to 10.6. Dr. Giancarlo Mari, MD played an indispensible role in that development.

Mari is a man of many titles. At the University of Tennessee Health Science Center, he’s a professor, chair of the Department of Obstetrics and Gynecology, and director of the Maternal-Fetal Medicine Fellowship. At Regional One Health, he’s the director of the High-Risk Obstetrics Center of Excellence.

He was born in Salerno, Italy, attended medical school at the University of Naples, completed a residency at the University of Parma, and taught and practiced in England and the Netherlands. Mari arrived in the U.S. in 1987, completing a research fellowship in pediatric cardiology at Baylor College of Medicine in Houston, then a physician-executive MBA from the University of Tennessee-Knoxville. He also received residency training in obstetrics and gynecology and maternal-fetal medicine at Yale University.

Mari, a dual U.S./Italian citizen, came to Memphis with his sights set on reducing the high infant-mortality rate in Shelby County. In 2008, he joined the faculty at the University of Tennessee Health Science Center (UTHSC) and, the same year, launched an innovative simulation program at Regional One Health, then called The Med.

He and his team looked at numerous models for decreasing infant mortality rates in the United States and abroad, but they ultimately decided to develop their own, called OB F.A.S.T., which stands for Obstetrical Feasible Approach to Safety Training.

The simulation-based model is designed to improve care for high-risk pregnancies and tackle the infant mortality rate. The model trains healthcare workers to efficiently handle obstetrical emergencies before, during and after delivery. These complications could include cardiac arrest, sepsis, anesthetic emergencies, respiratory distress, fetal heart rate distress, umbilical cord prolapse, and breech delivery.

It’s a multidisciplinary approach for dealing with emergencies before, during, and after delivery that stresses teamwork, effective communication, shared decision making, and exemplary knowledge of protocols for situations that require immediate response.

“Before 2008, infant mortality was above 20 percent of the expected rate,” says Mari, who humbly stresses that the program could not be successful without his team, particularly Dr. Danielle Tate, Bonnie Miller, RN, and Dr. Ravpreet Gill. “Since we started our program, the infant mortality rate dropped from 20 percent above the expected to 20 percent below the expected. Many people deserve credit for this.”

OB F.A.S.T has now trained between 500 and 1,000 health care providers in 20 U.S. states. Most recently, Mari and his team traveled to the province of Henan in China to share their successful model with healthcare practitioners there.

Mari was invited to China by Dr. Genxia Li, who had spent time working with Mari in Memphis in 2016 and was impressed with the program, particularly its multidisciplinary simulation training, which is relatively new in China.

“We were invited to go to China and to start the program over there,” says Mari, whose training manual has been translated into Chinese. “We trained doctors from 36 hospitals there. These doctors are now training other doctors in their own hospitals, and this is the reason our program is now becoming international. We plan eventually to look at other countries where we could go and train other people, as well.”

But OB F.A.S.T. is only one of Mari’s numerous accomplishments in saving the lives of mothers and babies. He also pioneered the assessment of fetal circulation with Doppler ultrasound. At Yale, he was the principal investigator of a multicenter research project that brought non-invasive Doppler ultrasound techniques to the diagnosis of fetal anemia. That protocol has since become the standard of care for the diagnosis of fetal anemia in the U.S. and many other countries.

He also developed a fellowship at UTHSC in maternal/fetal medicine to train physicians in high-risk obstetrical care and added a perinatal patient-safety nurse coordinator to the high-risk obstetrics program. He has brought cutting-edge surgery techniques to Regional One Health, the only Level 1 trauma center in a five-state region. He’s also a widely published researcher and internationally recognized author.

“I like the challenge,” Mari said. “My work in research has been focused on developing new tools and to discover new things … I always want to help other people and I want to develop new things.”

His innovation has meant the difference between life and death for high-risk pregnancy patients and their babies locally, nationally, and internationally.