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An Exploration of the Number and Reason for Attendance of Pregnant and Newly Postnatal Women at Emergency Department of University Hospital Birmingham

Leads: Prof Sara Kenyon, Felicity Evison, Catherine Atkin, 

Throughout the project, the team are working in partnership with public contributors linked to ARC WM's Maternity theme.

Dates: November 2020  December 2021

Background:

There is currently no standardised or specific triage process for pregnant and newly postnatal women who attend Emergency Departments (ED) with concerns or issues. The confidential enquiries into maternal death in the UK have identified this as resulting in delays in the recognition of the severity of illness, delaying treatment/ referral and potentially resulting in adverse outcome. Anecdotally, no standardised process or pathway and delayed referral to maternity services are problematic. Women usually attend Maternity Triage at Birmingham Women’s with pregnancy or postnatal related concerns or issues where there is a maternity triage system in place – the Birmingham Symptom specific Obstetric Triage System (BSOTS). However they may attend University Hospitals Birmingham (UHB) ED either by mistake or with a concern or complaint that is more appropriate for mainstay services. Triage systems within ED do not specifically address the physiological differences in pregnant women or the unborn foetus, and staff are not familiar with pregnancy specific issues. There is no standardised system or pathway in place and this undoubtedly presents increased risk. This data is collected in the EDs of the Queen Elizabeth Hospital and Heartlands who constitute UHB NHS Foundation Trust and both use the same electronic data collection system, which is stored by the PIONEER Health Data Research Hub. Should the project identify common reasons for attendance (such as chest pain, shortness of breath, acute perinatal mental health issues or early pregnancy concerns) the researchers intention is to develop, evaluate and disseminate a pregnancy and postnatal specific triage system for mainstay ED to improve clarity and safety.

Policy and Practice Partners:

PIONEER Health Data Research Hub at University Hospitals Birmingham.

Co-Funding Partners:

Margaret Peters Centre.

Aims and Objectives:

To explore the number of pregnant and newly postnatal women who attend UHBs Emergency Department (ED), the reason for their attendance, their gestation or time since birth, how unwell they are (the acuity score such as NEWS2/ SEWs), the time to referral to the obstetric/gynaecology acute medical unit/ general medicine services (if done), and whether the woman was admitted, transferred or discharged.

Methods:

This quantitative study shall use data from curated by PIONEER Health Data Research Hub who hold de-identified patient electronic health records from University Hospitals Birmingham NHS Foundation Trust. This project will be secondary analysis of their de-identified emergency department data.

Main Results:

As this project is secondary analysis of pre-existing data, ethical approval is already in place (REC 20/EM/0158 (East Midlands (Derby) & (CAG) 20/CAG/0084). The data for this project is currently being extracted and we are in the process of obtaining the Data Sharing Agreement between the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust.

Conclusions:

Forthcoming.

Implications for Implementation:

The intention is to develop, evaluate and disseminate a pregnancy and postnatal specific triage system for mainstay ED to improve clarity and safety.