Leads: Dr Nimarta Dharni, Prof Sara Kenyon

Dates: November 2022 – March 2024

Background:

Multiple national maternity safety reports have highlighted concerns contributing to avoidable harm to women and babies during labour. These include problems with multi-disciplinary team working, culture and communication, particularly when escalating clinical concerns. In 2019, the DHSC commissioned ‘Each Baby Counts Learn & Support’, a national programme to create solutions to the recurrent problems identified in safety reports. Using a blended approach underpinned by quality improvement and behavioural science theory, three interventions were designed and tested by a cohort of frontline midwives and obstetricians from a variety of maternity units across England. The interventions are:

1. Team of the Shift – a five-minute pre-clinical handover huddle to enable multi-disciplinary teams to easily identify who to escalate to and establish psychological safety at the start of every shift.

2. Advice –Inform-Do - safety critical phrases to make clinical escalations concise and precise.

3. Teach or Treat – promoting respectful feedback and learning conversations between colleagues for clinical escalation.

An online toolkit incorporating implementation resources and lessons for other maternity teams was developed. The Midlands is the first to implement the toolkit regionally following strong support from the Regional Chief Midwife. Implementation will be supported via further evaluation and partnership working.

Policy and Practice Partners: Regional Perinatal Service (NHS England & NHS Improvement - Midlands), WMAHSN, EMAHSN

Research question/ aim(s): To explore the implementation, impact, reach, adoption and sustainability of the clinical escalation toolkit and implementation approach

Study design: mixed methods study with health care professionals involved in the implementation of the clinical escalation toolkit in maternity units in the Midlands region of the UK.

Study participants: Midwives and Obstetricians involved in the implementation of the clinical escalation toolkit

Planned size of sample: 1) Pre and post survey with maternity staff across the East and West Midlands 2) pre and post interviews with site leads (n= up to 26 sites) and pre and post interviews with regional improvement leads (n=2); 3) interviews and/or focus groups with multidisciplinary maternity professionals from selected maternity units (n= 8-10 interviews across 4-5 sites); 4) non participant observation of implementation support meetings 

Results: Project currently underway

Conclusions: Project currently underway

Link to RCOG Clinical Escalation Toolkit: https://www.rcog.org.uk/about-us/quality-improvement-clinical-audit-and-research-projects/each-baby-counts-learn-support/escalation-toolkit/