Cheshire, James, Lissauer, David 
ORCID: 0000-0002-7878-2327, Parry-Smith, Will, Tobias, Aurelio, Smith, Gary B, Isaacs, Richard and Hundley, Vanora
(2021)
Escalation triggers and expected responses in obstetric early warning systems used in UK consultant-led maternity units.
RESUSCITATION PLUS, 5.
100060-.
Abstract
<h4>Background</h4>The use of obstetric early warning systems (OEWS) are recommended as an adjunct to reduce maternal morbidity and mortality. The aim of this review was to document the variation in OEWS trigger thresholds and the quality of information included within accompanying escalation protocols.<h4>Methods</h4>A review of OEWS charts and escalation policies across consultant-led maternity units in the UK (n = 147) was conducted. OEWS charts were analysed for variation in the values of physiological parameters triggering different levels of clinical escalation. Relevant data within the escalation protocols were also searched for: urgency of clinical response; seniority of responder; frequency of on-going clinical monitoring; and clinical setting recommended for on-going care.<h4>Results</h4>The values of physiological parameters triggering specific clinical responses varied significantly between OEWS. Only 99 OEWS charts (67.3%) had an escalation protocol as part of the chart. For 29 charts (19.7%), the only escalation information included was generic, for example to "contact a doctor if triggers". Only 76 (51.7%) charts detailed the required seniority of responder, 37 (25.2%) the frequency for on-going clinical monitoring, eight (5.4%) the urgency of clinical response and two (1.4%) the recommended clinical setting for on-going care.<h4>Conclusion</h4>The observed variations in the trigger thresholds used in OEWS charts and the quality of information included within the accompanying escalation protocols is likely to lead to suboptimal detection and response to clinical deterioration during pregnancy and the post-partum period. The development of a national OEWS and escalation protocol would help to standardise care across obstetric units.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Maternal health, Patient safety, Early warning systems, Patient escalation |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 29 Jun 2021 15:24 |
| Last Modified: | 18 Jan 2023 21:37 |
| DOI: | 10.1016/j.resplu.2020.100060 |
| Open Access URL: | https://www.sciencedirect.com/science/article/pii/... |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3128152 |
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