CPCQC is excited to introduce CORE: Colorado Obstetric Readiness in Emergency Care, a new statewide initiative designed to strengthen obstetric emergency readiness in rural and low-volume emergency departments across Colorado.
CORE will bring hands-on, simulation-based education directly to participating hospitals, giving emergency teams an opportunity to practice the recognition, stabilization, and response to obstetric emergencies within the environments where they actually provide care. The program is being developed specifically around the realities of rural emergency departments, including low patient volume, limited onsite obstetric resources, small care teams, and the need to stabilize and coordinate transfer when a higher level of care is required.
Why This Work Matters
Access to obstetric care is changing across Colorado, particularly in rural and frontier communities. Today, 37.5% of Colorado counties are classified as Maternal Care Deserts, meaning they have no labor and delivery or obstetric facilities or services. For patients living in these communities, accessing obstetric care may require traveling significant distances, and when an unexpected complication occurs, the local emergency department may become the first and sometimes only immediate point of care.
At the same time, rural hospitals continue to face significant workforce, financial, and operational challenges that can make sustaining labor and delivery services increasingly difficult. CPCQC’s recent examination of five rural Colorado hospitals found that facilities were balancing low delivery volumes with the ongoing need to maintain staffing, clinical skills, equipment, and systems necessary to respond safely when an obstetric emergency occurs. Even when a hospital no longer operates a labor and delivery unit, the need for obstetric readiness does not disappear. CPCQC’s rural hospital case study found that emergency deliveries continued to occur after L&D services were reduced or discontinued, prompting hospitals to strengthen transfer relationships, coordinate with EMS, and invest in staff training and simulation.
Low clinical volume creates another challenge. Obstetric emergencies may occur infrequently in rural emergency departments, but when they do occur, teams must be prepared to act quickly in situations that can rapidly become life-threatening. Limited exposure to these events can make it difficult to maintain procedural confidence, clinical skills, and coordinated team response over time. CPCQC’s rural hospital work identified these concerns specifically in relation to low-frequency, high-risk obstetric events, reinforcing the value of opportunities for teams to practice together before an emergency occurs.
The need for readiness has also taken on new urgency with updated CMS Conditions of Participation for obstetrical emergency services. Acute care hospitals and critical access hospitals that provide emergency services must maintain protocols addressing obstetric emergencies, complications, and immediate post-delivery needs, and applicable staff must receive annual training on those protocols. These requirements apply to hospitals providing emergency services regardless of whether they routinely provide obstetric care, underscoring the importance of ensuring that emergency teams have the knowledge, systems, and practice necessary to respond when an obstetric emergency arrives at their door.
That is the need CORE was built to address.
Bringing Obstetric Emergency Training to Rural Teams
CORE will bring hands-on, simulation-based training directly to participating hospitals, with education designed around the realities of rural emergency care. CORE trainings will be facilitated onsite by CPCQC clinical simulation faculty, including a RNC-MNN specialty certified Registered Nurse and an OB/GYN physician, bringing multiple perspectives to team-based obstetric emergency response. Training will focus on rapid recognition and stabilization, interdisciplinary communication and role clarity, obstetric emergency response, neonatal support, escalation of care, and transfer coordination.
Participants will work through realistic simulations and facilitated discussions addressing emergencies such as unplanned delivery, shoulder dystocia, postpartum hemorrhage, hypertensive emergencies in pregnancy, and maternal cardiac arrest. The goal is not only to strengthen clinical knowledge, but to give teams an opportunity to practice how they respond together — including communication, role assignment, use of available equipment and medications, escalation pathways, and transfer processes.
The curriculum is also intentionally aligned with relevant CMS Conditions of Participation priorities, including emergency preparedness, staff competency, patient safety, communication, stabilization, and quality improvement, helping hospitals strengthen both clinical readiness and their approach to meeting federal expectations.
What’s Next for CORE?
CORE’s first onsite training is planned for January 2027, with CPCQC aiming to deliver training at a minimum of five rural emergency departments during 2027. These initial site visits will allow CPCQC to learn alongside participating hospitals, evaluate the training model, and continue refining CORE as the program develops and expands.
CPCQC also plans to convene a CORE Steering Committee to help inform implementation, evaluation, and continued program development. The committee will bring together individuals whose professional expertise or lived experience is directly relevant to rural obstetric emergency care and who can contribute to the continued development of the program.
Those interested in being considered for the CORE Steering Committee may contact Dani Courtney, Clinical Simulation Program Manager, at dcourtney@cpcqc.org to be added to a list for future communications regarding committee eligibility and the application process. Questions about CORE, future training opportunities, or the program more broadly may also be directed to Dani at the same address.
