Optimising Obstetric HDU patient management; A Quality Improvement Project

INTRODUCTION

• Aim: Ensure obstetric women admitted in HDU receive care per Trust guideline for Enhanced Maternal Care.

• Objective: Audit critical care of obstetric patients at UHB.

METHODS

• Retrospective audit

• Data from BadgerNet

• Sample size: 100 patients

• Period: March–November 2023

AUDIT PARAMETERS

• Reason for HDU admission

• Antenatal/Postnatal

• MEOWS at admission

• Investigations done

• HDU-trained midwife

• Stay duration

• MDT ward rounds

• CCOT review

• ITU transfer

• Maternal outcomes

AUDITABLE STANDARDS

• MEOWS hourly

• MDT rounds twice/day

• HDU-trained midwife

• CCOT review if MEOWS ≥6

---

 

INDICATIONS FOR HDU ADMISSION (n=100)

• PPH – 58%

• Sepsis – 21%

• PET – 18%

• Cardiac/Bowel injury/AKI – 3%

• 80% Postnatal | 20% Antenatal

 

---

MODE OF DELIVERY

• 56% C-section

• 44% Vaginal birth

---

MEOWS AT ADMISSION

• <4 = 71%          > 4 = 29%

DURATION OF HDU STAY

• 1 day = 63%

• 2 days = 33%

• 3 days = 4%

---

Outcomes & Recommendations

KEY FINDINGS

✅ 100% had appropriate investigations
✅ 100% had MDT reviews twice daily
✅ 100% MEOWS form used
✅ 90% were looked after by HDU-trained midwife
✅ 3% had CCOT review
✅ 2% transferred to ITU

---

PERFORMANCE vs AUDIT STANDARDS

---

MATERNAL OUTCOME

All patients stabilised and discharged.

---

RECOMMENDATIONS

• Continue MDT reviews 12-hourly

• Maintain MEOWS documentation

• Escalate to CCOT when MEOWS ≥6

• Increase HDU-trained midwife coverage to 100%

• Re-audit in 1 year

• Expand to include GHH data