RCOG World Congress 2023

BACKGROUND

Up to 34% of women in the UK require an induction of labour (IOL) every year1
With increasing service demands, there can be delays in this pathway that may impact patient outcomes and satisfaction
Early amniotomy associated with lower rates of chorioamnionitis, post-partum fever and NICU admissions as well as shorter duration of labour and lower overall healthcare costs (Battarbee et al, Beckmann et al, Vadivelu et al.).

According to Chelsea & Westminster Hospital NHS Trust guidelines:

Delays of 2+ hours in labour ward transfer after successful amniotomy are considered an Amber Alert and require senior escalation

OBJECTIVES

To identify how frequently delays in labour ward transfer at Chelsea and Westminster Hospital are documented and escalated to a senior
To assess the relationship between delayed amniotomy and poor labour outcomes.

DESIGN

Retrospective audit conducted at Chelsea and Westminster Hospital maternity unit between July and August 2023
Standard: Trust policy for Chelsea and Westminster NHS foundation trust, Ockenden report recommendations

DATA COLLECTION

Inclusion of all women undergoing IOL between 28/07/22 and 22/08/22.
Screening of antenatal notes and electronic records (CERNER, K2, evolve)
Data extracted: Patient demographics, pregnancy related factors, timeline of induction, delays in transfer and labour outcomes including type of delivery, labour complications and APGAR scores.

DATA ANALYSIS

All statistical analyses were performed on Excel.

RESULTS

26 women identified and included for analysis
84% of women waited more than 2 hours for labour ward transfer
Range of waiting times was 0-28h

Reasons for delay were only documented in 20% of cases
Workload and staffing problems cited as main reasons for delay
No documentation of senior escalation identified

43% of women who waited more than 2 hours for labour ward transfer required an instrumental delivery due to failure to progress, compared with 25% of women who waited 2 hours or less.

Complications in women who waited less than or two hours versus more than 2 hours:

Intrapartum pyrexia (48% vs 25%)
Massive obstetric haemorrhage (67% vs. 50%)

Positive correlations were observed between an increased delay in transfer to labour ward and:

Total duration of labour
Estimated Blood Loss
APGAR scores at 1 minute.

However, correlations were not found to be statistically significant

CONCLUSIONS

There are delays in the transfer of women to labour ward
Assessment of adherence to escalation policy could not be assessed due to lack of documentation
Longer waiting times were associated with higher risk of obstetric complications, instrumentation, longer labour, and EBL, although differences were not statistically significant

RECOMMENDATIONS:

Raise awareness about current suboptimal documentation of IOL pathway delays and importance of improving documentation
Introduction of escalation stickers to be completed and added to patient notes

RCOG World Congress 2023

Senior escalation in Induction of Labour Pathway at Chelsea and Westminster Hospital

Poster Presenter

Authors

Affiliations

Part of Topic