Following the report into failings of maternity care at Morecambe Bay NHS Foundation Trust published earlier this year, improving quality in maternity services is a hot topic in the health service and the media. A major review of maternity services in England, led by Baroness Julia Cumberlege, is aiming to modernise care of women and babies. Our recent event brought together policy makers, health professionals, service users, advocates and, researchers – all with a common commitment to improving maternity care.
Scotland also has a dedicated collaborative and programmes of work currently looking to improve maternity services. Areas of particular focus are improving safety and reducing harm, and improving patient experience of care, for women and their families. These four projects, all recipients of Health Foundation support, have found innovative ways to do just that.
1. MaternityPEARLS – internet-based training package
MaternityPEARLS is a web-based learning package for practitioners carrying out medical procedures on women with perineal injury sustained during childbirth. It has now been adopted by two royal colleges as part of their online learning programmes.
Developed by the University Hospital North Staffordshire NHS Trust, MaternityPEARLS aimed to reduce morbidity associated with childbirth-related perineal trauma, and to improve women’s experience of maternity care. The team built on the PEARLS national clinical quality improvement initiative which improved implementation of evidence-based guidelines for the management of childbirth-related perineal trauma.
The training package is now available free on the Royal College of Midwives i-learn menu and also the Royal College of Obstetrics and Gynaecology StratOG menu and has proved popular. Assessments conducted in three maternity units showed that the training significantly improved clinical skills in the assessment and repair of perineal trauma, while also delivering cost savings.
2. The My Birthplace app
My Birthplace, an app that helps pregnant women and their partners decide where they would rather have their baby, has led to more effective workforce and resource planning as a result of faster decision-making by parents.
Portsmouth Hospitals NHS Trust developed this computerised decision-making tool to help pregnant women and their partners to choose whether they would prefer to have their baby on a hospital labour ward, in a midwife-led unit or at home.
Research shows that in the case of low-risk pregnancies, babies born at home or at midwife-led units do as well as babies born in hospital obstetric units, with fewer interventions. However in England, 85% of women give birth in an obstetric unit, even though most live equally close to a maternity-led unit.
The My Birthplace app received strong feedback from users and led to a significant increase in the proportion of women who had made a decision about where to give birth by 36 weeks.
As well as being commissioned in Portsmouth, the app is now about to be rolled out across the whole of Wessex and has also been commissioned in Scotland.
3. PROCEED pre-pregnancy care in diabetes
The innovative PROCEED model of community-based pre-pregnancy care for women with diabetes, resulted in improved effectiveness, efficiency and timeliness of pre-pregnancy care for women with diabetes, reducing the average waiting time from 13 to five weeks.
Led by Derby Hospitals NHS Foundation Trust, the PROCEED project succeeded in reducing the percentage of babies stillborn to mothers with diabetes from 6% to 0%, and delivered a financial saving of £60,000 in its first year.
The team is now keen to show how the PROCEED model would also be applicable for other high-risk groups of women, and has developed a website aimed at commissioners and health professionals to encourage other services to adopt the model.
4. PROMPT Course in a Box
The ‘PROMPT Course in a Box’ is a multi-professional obstetric training programme which reduces preventable harm during emergencies in childbirth. Since its roll-out, PROMPT has been associated with improved knowledge, communication, team-working and direct improvements in perinatal outcome, and has now been adopted by most maternity units in the UK.
Developed by a team at Southmead Hospital in Bristol, the box contains manuals and all the multimedia materials needed to run the course, making PROMPT easily shared with other maternity units who want to use it.
The PROMPT Course in a Box was initially rolled out across North Bristol NHS Trust. After introducing the training at Southmead Hospital, there was a 50% reduction in babies born starved of oxygen, and a 70% reduction in babies born with a paralysed arm after getting stuck in the birth canal.
In England, 75% of trusts have adopted PROMPT, and it is being rolled out in Scotland as part of the National Maternity QI Collaborative. The team is now introducing the tool internationally.