The Health Roundtable

Information

Presenter: Eastern Health

Hospital Code Name: Hawk

Innovation Poster SessionHRT1104b – MaternityMarch 10-11 2011

The Health Roundtable

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•4,500+ births annually

•Multiple maternity models of care

•3 maternity birthing hospitals

•Satellite units for provision of community antenatal care

•Level 1-5 maternity care (Capability framework for Victorian maternity and newborn services)

About Eastern Health

The Health Roundtable

KEY PROBLEM

Key themes from adverse events

Poor communication Poor documentation Lack of teamwork and Lack of maternity care planning Around half of the serious adverse events

involved women with BMI >35

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AIM OF THIS INNOVATION

Improvement Sought Documented care planning to inform management

of all women, including obese women Clear lines of consultation, referral, communication

and documentation across the multidisciplinary team

Clear pathways of maternity care Improved teamwork Safe, quality maternity care Improved perinatal outcomes Minimise incidence of adverse events and clinical

risk Making the woman the centre of maternity care

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BASELINE DATA

Identified that out of 10 serious adverse events, 4 were associated with women who had a BMI >35

Processes and systems that were inconsistent and unclear to all

Different practices in documentation, communication, consultation and referral between sites and across sites

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KEY CHANGES IMPLEMENTED

Expected Pathways of care Right clinician at the right place and time

regardless of Eastern Health site. Care is streamed into one of two pathways, depending upon the needs of the woman:

Green: Healthy woman with uncomplicated pregnancy Red: Woman with medical/ obstetric condition that is complicating the

pregnancy and requires assessment and planning by the appropriate level of clinician

Consistent clinical practice and consultation and referral guidelines across all sites

Eastern Health hand held maternity record Linkages to key changes via an informatics

strategy

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OUTCOMES SO FAR

In the process of implementation- pilot study completed and modifications being made to care pathway ‘guidance’ tools

Recognition of problems with maternity management and planning for obese women – now a clearly identified ‘red pathway’ requiring collaborative care to be planned by obstetric consultant for pregnancy and birth

Supporting documentation and information through Eastern Health hand held maternity record

Improved clinical information, documentation and decision making, reducing clinical risk, improving women’s engagement with care, and improving outcomes

The Health Roundtable

LESSONS LEARNT

A multidisciplinary consultative/collaborative approach, as well as a huge amount of time and discussion required to plan and implement changes

Inter-relationship between education and training, documentation systems (hand held record, BOS, Healthsmart) and IT systems require simultaneous organisational effort

Use and availability of outside resources – NICE, ACM, etc required, internal goodwill and resources to develop context specific resources is essential