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The setting
The Midlands has 21 Trusts (26 sites) providing maternity services from the East Coast to the borders with Wales. There were 103,990 babies born in 2021-22 in these units with an average IOL rate across the UK being around 34% (NMPA Clinical Report 2022). The maternity units range from small units with co-located level 1 neonatal services to large multi-site units with level 3 neonatal and surgical services. IOL forms a significant part of the scheduled and unscheduled care undertaken and thus impacts significantly on the ability of these organisations to deliver safe and timely care.
The problem
The Regional IOL Framework was developed in late 2022 after the regional escalation situation report (SitRep) identified inductions as a significant contributor to the workload of provider organisations and that they were over-represented in the data looking at delays in care.
Concerns were raised regarding increased risk to those women and babies from a number of sources as well as identifying variations in practice and differing application of evidence -based recommendations around IOL (IOL), in particular relating to indications and timing of induction.
The project
A regional ‘Task and Finish’ was formed in August 2022, containing midwives and obstetricians from provider organisations, service user representation as well as members from local maternity and neonatal systems. This was supported by members of the project management team from NHS England including the Regional Lead Obstetrician allowing identification of key concerns and opportunities for unifying guidance and recommendations to ensure consistency and reduction in unwarranted variation around IOL practices.
The Task and Finish group also developed quality indicators for the Regional Operational Pressures Escalation Levels (OPEL) escalation Sit Rep to help standardise escalation language and triggers to help ensure appropriate prioritisation and recognition of those at highest risk rather than a ‘first come, first served’ approach.
The framework based its recommendations on national guidance sourced from NICE, RCOG Green-top Guidelines and the Saving Babies’ Lives Care Bundle (v2) with a request for provider organisations to benchmark themselves against these, giving an insight into where gaps or variation in practice occurred. This was not intended to discourage variation entirely, but to allow sharing of the evidence with service users and staff, and to encourage better discussions to support personalised care and supported decision-making. This would also allow Trusts and Integrated Clinical Boards/Local Maternity and Neonatal Systems’ to understand where risks may be being carried by practice not supported by national recommendations and guidelines.
The Impact
The Framework (see link) was published in February 2023 alongside the Regional OPEL escalation SitRep. The aim is to evaluate the impact of the structured guidance provided by the framework on the delays in care and need for escalation/mutual aid by standardising the ask for indication and timing of IOL. We anticipate that the SitRep should help identify whether organisations are frequently in escalation and to be able to use the Framework to identify opportunities to assess whether the decision-making is as robust as is required.
For more information contact:
Susie Al- Samarrai lead Obstetrician for the Midlands- susanna.al-samarrai@nhs.net
Janet Driver Deputy Chief Midwife for the Midlands- janet.driver3@nhs.net
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