ANTEnatal care improvement for prediction and treatment of adverse pregnancy events (ANTICIPATE)

Timely antenatal care (ANC) is crucial to providing quality care to women and their babies. ANC aims to detect, prevent and manage pregnancy complications to reduce maternal and neonatal morbidity, mortality and long-term health issues. In the Australian maternity care system, general practitioners (GPs) offer early pregnancy care and refer women to maternity care providers.

Following referral, pregnant women typically have an initial ‘booking in’ visit with hospital-affiliated midwives. However, the timing of this first hospital contact varies nationwide, occurring between 12 to 28 weeks into pregnancy, with the average for Royal Prince Alfred Hospital (RPA) being 17 weeks. Only 30% of women birthing at RPA receive a Combined First Trimester Screening (cFTS). cFTS, which includes an ultrasound and blood test, can pick up risks in a timely manner, such as pre-eclampsia, which can lead to serious complications for both mother and baby. This is due to limited resources, which are allocated on a first-come, first-serve basis, leading to an unequal distribution of healthcare services among women who give birth at RPA Hospital.

Emphasising the importance of early pregnancy care and screening

The current care model focuses on increased visits in later stages of pregnancy to detect complications promptly. However, with advancements in medical knowledge and technology, it is now possible to detect and treat complications earlier in pregnancy. This emphasises the importance of early engagement with pregnancy services to facilitate access to time-sensitive first trimester screening tests (which includes cFTS) and the provision of health promotion, education and nutritional information.

The recommended gestation of 14 weeks and under for first appointments is only met by 25% of women at RPA. The aim of this project is to increase this percentage and improve the quality of antenatal care by partnering with primary healthcare providers, and by prioritising early referrals to ensure timely pregnancy care, ideally at the same appointment time as cFTS. The project aims to reduce the incidence of pregnancy complications and decrease the cost of care for the healthcare system and the community.

Improving communication and education

Using redesign methodology and engaging with key stakeholders, diagnostic work identified several issues for addressing through speaking to women, staff, process mapping and root cause analysis work. The main issues identified were:

• lack of and misinformation to women from the service and GPs regarding expectations and requirements in the early pregnancy journey
• barriers in accessing the service for further information and follow up of referrals
• delays in appointment scheduling and notification
• inability to provide cFTS appointments to all women and delay in uptake on e-referral service by GPs
• preference of GPs to refer to private providers for ultrasound due to established and easy pathways for referral and receiving of results.

These will be addressed through the implementation of three main solutions which include improved communication to women, education and information to GPs and internal process improvement and models of care. Working groups for each solution have been set up to report to a steering committee on progress against all tasks within the solution groups. While the project is currently in the implementation stage, a few quick wins have been achieved. All women who are referred through Engage Outpatients now receive a notification that their referral has been received and when to expect their appointment. 100% of Antenatal Shared Care GPs now refer electronically through Engage Outpatients, which has resulted in decrease in fax referrals. Referral process time has also decreased by 50% (16 days to 8 days).

View this project's poster from the Centre for Healthcare Redesign graduation May 2024.

References