Westmead Hospital, located in Western Sydney Local Health District (WSLHD), is a tertiary referral hospital serving the diverse population of western Sydney. The hospital is known for its comprehensive and highly specialised services, particularly in women’s and newborn health.
Latest data from the NSW Quality Improvement Data System (in 2024) reveals that the birth rate at Westmead Hospital is the highest in NSW, with approximately 5,000 births and close to 100,000 occasions of service. For some expectant mothers, pregnancy can be an anxious time, especially when they experience issues such as vaginal bleeding, abdominal pain and concern about their baby’s movements. Currently, care for women presenting with acute pregnancy-related concerns at Westmead Hospital is provided by several separate clinical services. These include the emergency department (ED), the day assessment unit and the birth unit.
Which clinical service provides care for a woman depends on factors including stage of gestation, the time of day she presents and staffing levels within the clinical services, rather than on the urgency of her clinical presentation. This makes it difficult for women to access the care they need. They can also face long wait times for care, exacerbating uncertainty and stress.
Providing timely and appropriate maternity services
This project aims to improve both the patient and staff experience in receiving and providing timely, coordinated and appropriate maternity services. The project team undertook consultation with key stakeholders through process mapping, time-and-motion studies, interviews, surveys and data analysis. For women presenting to the ED, the average wait time to be seen was 126 minutes. While wait times were shorter in the day assessment and birth units overall, 30% of concerns reported in patient surveys and interviews were related to wait times, 65% of women reported not being informed about the estimated wait time, and at times the care did not meet their expectations.
When asked about the main reasons for dissatisfaction with working in the day assessment unit, 37% of staff cited high workloads and long wait times, while 15% identified delays in escalation for medical or consultant reviews as a significant challenge. Other key issues included difficulty knowing if women were waiting to be seen; being unable to triage the urgency of care for women less than 20 weeks due to insufficient information; lack of communication; and inconsistencies in the care provided.
Reducing wait times and presentations
Through the consultation, the project team identified four key issues:
- wait times
- care not meeting patient expectations
- inefficient clinical and system processes in the day assessment unit
- staff workload.
The team identified and developed solutions with the aim to:
- halve the proportion of women 20 weeks gestation or more presenting to the day assessment unit needing to wait above the mean wait time of 26 minutes
- decrease the mean wait time for women under 20 weeks gestation presenting to ED with vaginal bleeding or abdominal pain from 126 to 60 minutes
- halve the annual number of presentations to ED by women under 20 weeks gestation (1,448 to 724)
- improve the staff 'enjoyment of working in the day assessment unit' score from 61% to 90%.
Helping pregnant women avoid the emergency department
The project team designed solutions to improve awareness, access and efficiency of care, with a vision to have a separate maternity assessment centre where women with acute pregnancy concerns can present directly, avoiding ED and receiving care from a specialised team. Solutions include:
- improving the availability and awareness of information for pregnant women by updating the Westmead Women’s and Newborn Health and the local Primary Health Network (WentWest) websites
- improving access to care for women under 20 weeks by enhancing the early pregnancy service through a direct phone advice line (phase 1) and establishing the maternity assessment centre (phase 2).
- improving efficiency in processes and communication in the day assessment unit through:
- rearranging scheduled appointments to minimise overlap of booked and walk-in appointments and distribute workload
- introducing a clinical triaging system for women 20 weeks gestation or more, to assess the urgency of presenting complaints and aid in clinical decision making
- improving communication among the clinical team with formal safety huddles and an overview whiteboard.
The implementation phase has begun, with a focus on solutions relevant to the day assessment unit. The project team is scoping is to determine comprehensively the requirements for a maternity assessment centre. This centre, if established, will require embedding of our other solutions to be effective.
View this project's poster from the Centre for Healthcare Redesign graduation May 2025.
