Use of Maternal Early Warning Trigger Tool Reduces Maternal Morbidity

Shields, Laurence E.; Wiesner, Suzanne; Klein, Catherine; Pelletreau, Barbara; Hedriana, Herman L.

doi:10.1097/01.aoa.0000511993.68398.fa

Cited by 16 publications

(35 citation statements)

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“…There was no change in the proportion of obstetric complications, ICU admission and length of hospital stay following EWS implementation. Obstetric EWS have been previously shown to prevent progressive obstetric morbidity (14,(24)(25)(26). In contrast to our ndings also, Shields and colleagues, in a large multicentre quasi-experimental trial, reported a signi cant reduction in severe and composite maternal morbidity (p < 0.01) as de ned by the Centre for Disease Control (CDC), but not mortality, in six intervention hospitals following EWS implementation, compared to 19 controls (26).…”

Section: Discussioncontrasting

confidence: 95%

“…In contrast to our ndings also, Shields and colleagues, in a large multicentre quasi-experimental trial, reported a signi cant reduction in severe and composite maternal morbidity (p < 0.01) as de ned by the Centre for Disease Control (CDC), but not mortality, in six intervention hospitals following EWS implementation, compared to 19 controls (26). However, they also observed no change in the ICU admission rate in either the intervention or control hospitals (26). We are aware that clinical outcomes would only have been improved if completion of the EWS had led to an escalation of intervention, physician assessment as speci ed by the system, and the institution of appropriate interventions.…”

Section: Discussionmentioning

confidence: 95%

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Implementation and Evaluation of Obstetric Early Warning Systems in tertiary care hospitals in Nigeria

Umar

Ibrahim

Liman

et al. 2020

Preprint

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BackgroundObstetric Early Warning Systems (EWS) use combined clinical observations to predict increased risk of deterioration and alert health workers to institute actions likely to improve outcomes. The objective of this study was to assess the effectiveness of a validated obstetric EWS in improving health outcomes and explore the experience of health workers/managers regarding its use.MethodsThis mixed-method study included 2400 obstetric admissions to inpatient wards between 1 August 2018 and 31 March 2019 at three tertiary Nigerian hospitals (1 intervention and 2 control). The quality of patient monitoring and prevalence of outcomes were assessed through retrospective review of case notes before and 4 months after EWS was introduced. Outcomes were maternal death, direct obstetric complications, length of hospital stay, speed of clinical review, caesarean section (CS) and instrumental birth rates. Qualitative data was collected to explore the views of healthcare workers on EWS’ acceptability and usability.ResultsEWS correctly used in 51% (n=307) of cases. Of these, 58.6% (180) predicted to have increased risk of deterioration, and 38.9% (n=70) were reviewed within 1 hour. There was a significant improvement in the frequency of vital signs recording in the intervention site: observed/expected frequency improved to 0.91 from 0.57, p<0.005, but not in the control sites. CS rate reduced from 39.9% to 31.5% (chi-square p=0.002). No statistically significant effect was observed in the other outcomes.Health workers reported that the EWS helped cope with work demands while making it easier to detect and manage deteriorating patients. Nurses and doctors reported that the EWS was easy to use, and that scores consistently correlated with the clinical picture of patients.Identified challenges included rotation of clinical staff, low staffing numbers and monitoring equipment.ConclusionThe implementation of EWS improved the quality of patient monitoring, but a larger study will be required to explore the effect on health outcomes. With modifications to suit the setting, coupled with regular training, the EWS is a feasible and acceptable tool to cope with the unique demands faced in low-resource settings. Trial registration: ISRCTN, ISRCTN15568048. Registration date; 9/09/2020- Retrospectively registered, http://www.isrctn.com/ISRCTN15568048

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 95%

Implementation and Evaluation of Obstetric Early Warning Systems in tertiary care hospitals in Nigeria

Umar

Ibrahim

Liman

et al. 2020

Preprint

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“…25 Maternal early warning system can be implemented during the antenatal to postpartum periods, but it is primarily implemented in hospital settings when a patient is admitted. 26,27 In contrast, the maternal comorbidity index can be used to detect high-risk women, even before pregnancy, for example, during preconception care in primary care settings, as it captures chronic conditions in addition to pregnancy-induced conditions, and can be used to refer these high-risk women to higher level of care. 15 To that end, the objective of this study was to examine the association between maternal comorbidity index and SMM among delivery hospitalizations in Texas.…”

Section: Introductionmentioning

confidence: 99%

Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

Salahuddin

Mandell

Lakey

et al. 2019

Birth

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Background Severe maternal morbidity (SMM) prevalence was 194.0 per 10 000 deliveries in Texas in 2015. Chronic, behavioral, and pregnancy‐induced conditions, as captured by a maternal comorbidity index, increase the risk for delivery‐related morbidity and mortality. The objective of the study was to examine the association between maternal comorbidity index and SMM among delivery hospitalizations in Texas. Methods Delivery‐related hospitalizations among Texan women aged 15‐49 years were identified using the 2011‐2014 Texas all‐payer inpatient hospitalization public use data files (n = 1 434 441). The primary outcome of interest was SMM, based on the Alliance for Innovation on Maternal Health's coding scheme. The exposure of interest was a maternal comorbidity index. Multivariable logistic regression model was used to examine the association between maternal comorbidity index and SMM. Results SMM prevalence remained consistent between 2011 and 2014 (196.0‐197.0 per 10 000 deliveries, P > .05; n = 1 434 441). Nearly 40% of delivery‐related hospitalizations had a maternal comorbidity index of at least 1, and the proportion of deliveries in the highest risk category of comorbidity index (≥5) increased by 12.0% from 2011 to 2014. SMM prevalence was highest among the youngest and oldest age groups. With each unit increase in maternal comorbidity index, the odds of SMM increase was 1.43 (95% CI 1.42‐1.43). Conclusions Maternal comorbidity index is associated with SMM; however, the low predictive power of the model suggests that other, unmeasured factors may influence SMM in Texas. These findings highlight a need to understand broader contextual factors (practitioner, facility, systems of care, and community) that may be associated with SMM to reduce maternal morbidity and mortality in Texas.

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“…Highest risk points for this failure were OB triage visits and emergency department visits in the postpartum period. To mitigate these risks, we: Adopted a detailed HDP CPG (based on the 2013 ACOG HDP Task force 16 ) including outpatient assessment/diagnosis, indications for hospitalization and/or delivery, and emergent treatment of elevated blood pressures Adopted a maternal early warning system (MEWS) for postpartum patients 17–19 Adopted the Association of Women’s Health, Obstetric, and Neonatal Nurses POST-BIRTH Warning Signs as standard patient education on discharge 20 Provided blood pressure cuffs to all patients with hypertension, together with education on when to present to the hospital based on home monitoring Educated emergency department physicians on postpartum hypertension 21 Mandated critical care transport of HDP patients from outlying hospitals 22 Required completion of online learning module “Hypertensive Disorders of Pregnancy” by all providers and nurses every two years …”

Section: Methodsmentioning

confidence: 99%

Malpractice litigation, quality improvement, and the University Hospitals Obstetric Quality Network

Cossler

Liu

Porter

et al. 2019

Journal of Patient Safety and Risk Management

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Objective: A healthcare organization's medical malpractice data can help identify patient safety risks and drive improvement. In most organizations, obstetric malpractice losses are assumed to be part of the risk of delivering obstetric care. We describe a systematic approach to mitigating risks for obstetric patients and their newborns while simultaneously improving patient outcomes and reducing obstetric litigation costs at University Hospitals, a northeast Ohio-based health system of 18 hospitals, including seven hospitals providing obstetric services and delivering approximately 8000 women per year. Methods: From multiple data sources, including malpractice claims data, the team identified four key drivers of risk on the obstetric service: hypoxic ischemic encephalopathy, obstetric hemorrhage, hypertensive disorders of pregnancy, and shoulder dystocia. Collectively, these contributed to multiple adverse maternal and neonatal outcomes and accounted for 71% of obstetric litigation costs from 2009 to 2015. In response, the team built a regional obstetric quality network and implemented interventions to mitigate the four major risk areas. Results: We achieved a substantial reduction in serious safety events from 2010 to 2018, defined as any event where the standard of care was not met and the level of harm to mother or baby was one (death) or two (severe permanent or temporary harm). We also achieved a reduction in obstetric litigation costs between 2009-2012 and 2015-2018. Discussion: This multifaceted intervention was associated with decreased patient harm and reduced obstetric litigation costs. Application of this approach to other hospitals could result in improvements in obstetric patient safety and reduced obstetric litigation costs.

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Use of Maternal Early Warning Trigger Tool Reduces Maternal Morbidity

Cited by 16 publications

References 0 publications

Implementation and Evaluation of Obstetric Early Warning Systems in tertiary care hospitals in Nigeria

Implementation and Evaluation of Obstetric Early Warning Systems in tertiary care hospitals in Nigeria

Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

Malpractice litigation, quality improvement, and the University Hospitals Obstetric Quality Network

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