Audit: Appropriate Use of the Consultant-led Antenatal Care Referral Pathway
  
C.Hope,N.Goodwin-Thomas,C.Santacroce,J.Evans,M.Nairand M.El-El-Talatini
Singleton Hospital-Swansea Bay University Hospitals, Swansea, UK
 





Background:
COVID-19 caused a global healthcare crisis. Across the UK, maternity services were modified in response to the pandemic with maternity patients deemed as ‘moderate-high risk’. National guidance on how to adjust these services were issued.[1] The measures taken during the COVID-19 pandemic had the potential to disrupt the provision of the antenatal pathway, for example, patients being referred inappropriately to consultant-led clinics as per the Swansea Bay University Healthboard(SBUHB) maternity services criteria list.[2]
 


Objective:
To assess the  referrals made to consultant-led units, and ascertain whether COVID-19 has since had an effect on the appropriate use of the referral pathway.
 
Design & Method:
A proforma was developed to investigate whether patients referred to consultant-led care met the criteria list for referral. The proforma was distributed to five clinics with five different consultants. The proforma results were collated and categorised into appropriate and inappropriate referrals including reasons for indication.
 
Results:
A total of 51 responses were recorded, of which 90% met the antenatal SBUHB Maternity Services Criteria list for consultant-led care 2020. A total of 5 referrals were classified as inappropriately referred; these referrals were made due to: high BMI but below threshold (<40); presence of fibroid or polyps; concern regarding age of mother but was below that of the criteria (<40yo). 22 of the first appointments took place during the second trimester and 29 took place during the third trimester. Reasons for appropriate referral included BMI> 40, small for gestational age, high maternal age, maternal comorbidities, previous caesarean section, previous thromboembolism, preeclampsia, maternal smoking as well as gestational diabetes mellitus. 
 
Conclusions:
Whilst 10% of referrals were deemed inappropriate, indications for these referrals were present and made using the midwives clinical judgement. The criteria list states for midwives to use their clinical judgement, perhaps there needs to be clearer guidance in which scenarios this applies to.
 
References

[1] Guidance for Antenatal and Postnatal Services in the evolving Coronavirus (COVID-19) pandemic(2020). Available at: https://www.rcog.org.uk/media/5reddquc/2020-10-21-guidance-for-antenatal-and-postnatal-services-in-the-evolvin.pdf (Accessed: January 31, 2023).
[2] Owens, V. (2020) Maternity Services Criteria List for Consultant Led Care.