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A national survey of obstetric early warning systems in the United Kingdom
R D J Swanton1, S Al-Rawi, M Y K Wee
1Department of Anaesthesia, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK. robandlou@doctors.org.uk
Insights
A national obstetric early warning scoring (EWS) system is needed. Survey results show strong support for developing a standardized EWS for the obstetric population, aligning with Confidential Enquiries into Maternal and Child Health recommendations.
Area of Science:
- Obstetrics and Gynecology
- Anesthesiology
- Healthcare Systems Improvement
Background:
- Current early warning scoring systems (EWS) are not validated for obstetric patients.
- Recommendations from Confidential Enquiries into Maternal and Child Health (CEMACH) highlight the need for improved obstetric monitoring.
- Existing EWS in general adult populations show potential for patient care enhancement.
Purpose of the Study:
- To assess UK consultant-led obstetric anaesthetic units' opinions on a standardized national obstetric EWS.
- To determine the perceived value and feasibility of implementing an obstetric EWS.
- To gather insights for developing a relevant and effective obstetric EWS.
Main Methods:
- A postal survey was conducted in November 2007 among all UK consultant-led obstetric anaesthetic units.
- The survey, approved by the Obstetric Anaesthetists' Association (OAA), assessed opinions on obstetric EWS value and implementation.
- Units were invited to provide comments and examples of existing systems.
Main Results:
- A 71% response rate was achieved.
- A median usefulness score of 80% was reported for a standardized national obstetric EWS.
- 89% believed implementation was possible, despite 96% using non-obstetric EWS, only 23% found them relevant to obstetric physiology.
Conclusions:
- Survey findings strongly support the CEMACH recommendations for a nationally agreed obstetric EWS.
- There is significant perceived value and feasibility for implementing an obstetric EWS.
- The study informed the local design and submission of a novel obstetric EWS to the OAA.
Background:
Despite recommendations in the two most recent Confidential Enquiries into Maternal and Child Health (CEMACH) reports, and improvements in patient care using early warning scoring systems (EWS) in the general adult population, no validated system currently exists for the obstetric population.
Methods:
We performed an Obstetric Anaesthetists' Association (OAA) approved postal survey of all UK consultant-led obstetric anaesthetic units in November 2007 to assess opinions on the value and of such a system and how it could be implemented, and invited comments and samples of systems already in use.
Results:
The response rate was 71%. Of those who replied a median usefulness score of 80% for a standardised national obstetric EWS was demonstrated. Eighty-nine percent of units thought it would be possible to implement a system, and although 96% of UK hospitals already use a non-obstetric EWS, only 23% of respondents thought this to be relevant to obstetric physiology and disease. Nine units returned copies of their obstetric EWS. Using extracts from some of the submitted versions we have designed and implemented a system locally and submitted it to the OAA for consideration.
Conclusions:
The survey results support CEMACH recommendations for a nationally agreed obstetric EWS.
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