Wollongong Hospital established a consultant-led pre-anaesthetic clinic for women with high-risk pregnancies. It ensures women are supported during their pregnancy and delivery, and clinicians are prepared for any medical issues that may arise.
To ensure that within six months, more than 90 per cent of women with high-risk pregnancies are seen by a consultant anaesthetist within two weeks of being identified as high risk.
- Improves education for women on the analgesia options available and their risks.
- Provides an opportunity for women to speak with an anaesthetist before their delivery date and address any concerns while they are comfortable.
- Increases familiarity with and confidence in the anaesthetic service.
- Improves the quality of care, by allowing time to properly investigate and plan for identified difficulties.
- Improves staff satisfaction and collaboration with other departments.
- Improves the quality of handover between clinic and ward staff.
In May 2016, a woman with a very high-risk pregnancy presented to Wollongong Hospital in early labour and was treated by a different obstetrician and anaesthetist than the ones she had seen throughout her pregnancy. While there was no harm to the patient or her baby, the new team were not prepared for such a high-risk pregnancy. At the time, there was no specific pathway for high-risk patients to be identified or managed and no formal lines of communication between the anaesthetic and obstetric departments, which would have alerted them to a potentially difficult patient. When discussed at a departmental meeting, a number of staff reported cases that would have been better managed had there been a means of identifying high-risk patients and communicating their needs across multiple departments.
A consultant-led pre-anaesthetic clinic for women with high-risk pregnancies was established. The clinic aims to meet with the woman and her support person before her planned delivery date, to provide education on the different forms of analgesia available and their risks, as well as any interventions available for her condition. The clinic also alerts the Department of Anaesthesia to any medical issues, so they are prepared to address them when the woman is admitted.
A clinic slot was permanently added to the department roster and staffed with consultant anaesthetists. The obstetric team screened patients for high-risk pregnancy using a checklist developed as part of the project, and referred them to the new anaesthetic clinic. Obstetricians and antenatal clinic staff were educated about the new clinic and encouraged to refer all high-risk pregnancies to the clinic for review. Other departments were advised, depending on the individual needs of the woman, such as the blood bank or vascular team.
The handover process was improved between clinic and ward staff, to ensure there are no problems or delays when a woman with a high-risk pregnancy arrives in an emergency. This process includes a prompt to call the consultant anaesthetist who is prepared to manage the situation. The new handover provides staff with the time to complete appropriate investigations and plan for any potential difficulties that may arise.
Sustained – The project has been implemented and is sustained in standard business.
1 November 2016 – 1 November 2017
Wollongong Hospital, ISLHD
A full evaluation will be conducted in November 2017, measured by:
- number of referrals to the pre-anaesthetic clinic
- number of patients seen by consultant anaesthetists
- noted health outcomes for high-risk pregnancies
- surveys to measure patient satisfaction with the clinic.
As of July 2017, there has been a marked improvement in communication between anaesthetic and obstetric departments. A recent high-risk case proceeded very smoothly, with a much lower use of blood products than anticipated as a result of the teamwork and preventative measures implemented. The patient was fully aware of all planned interventions and potential complications, and was very happy with the outcome.
- Communication is key. Improving communication and maintaining that improvement makes all the difference.
- It is important to develop clear guidelines and encourage clinic staff to ask questions early, to prevent confusion.
- Start with volunteers who care about the project, then introduce late adopters when the need for change is established in everyone's minds.
- Try to provide positive updates on a regular basis and address any problems as soon as possible.
Australian and New Zealand College of Anaesthetists (ANZCA). Guidelines on Pre-Anaesthesia Consultation and Preparation. Melbourne, VIC: ANZCA; 2017.
Name: Orysia Sandry
Position: Co-Director, Department of Anaesthesia
Organisation: Wollongong Hospital, ISLHD
Phone: 02 4255 1564