RT Journal Article
SR Electronic
T1 Rapid quality improvement in a preterm birth clinic care pathway during the COVID-19 pandemic
JF BMJ Open Quality
JO BMJ Open Qual
FD British Medical Journal Publishing Group
SP e001049
DO 10.1136/bmjoq-2020-001049
VO 9
IS 4
A1 Sara Zarasvand
A1 Erna Bayar
A1 Malko Adan
A1 Katherine Mountain
A1 Holly Lewis
A1 Karen Joash
A1 TG Teoh
A1 Phillip R Bennett
A1 Sabrina Das
A1 Lynne Sykes
YR 2020
UL http://bmjopenquality.bmj.com/content/9/4/e001049.abstract
AB Background Preterm birth (PTB) occurs in 8% of births in the UK. At Imperial College Healthcare NHS Trust, our PTB prevention clinic manages the care of approximately 1000 women/year. Women referred to the clinic are seen from 12 weeks of pregnancy with subsequent appointments every 2–4 weeks to measure cervical length (CL) using transvaginal ultrasound (TVUS). Women with a history of cervical weakness or short cervix on TVUS are offered a cervical cerclage.Local problem During the COVID-19 outbreak, pregnant women were strongly advised to avoid social mixing and public transport. The National Health Service had to rapidly adopt remote consultation and redesign clinical pathways in order to reduce transmission, exposure and spread among women at high risk of PTB.Methods We focused on Specific, Measurable, Achievable, Realistic and Timebound aims and used a driver diagram to visualise our changes. We used a series of Plan Do Study Act cycles to evaluate and adapt change ideas through the UK’s national lockdown during the COVID-19 pandemic between 23 March and 29 May 2020.Results We reduced the number of face-to-face appointments by 54%. This was achieved by increasing remote telephone consultations from 0% to 64%, and by reducing the intensity of surveillance. The rate of regional anaesthetic was increased from 53% to 95% for cerclage placement in order to minimise the number of aerosol-generating procedures. Patient and staff satisfaction responses to these changes were used to tailor practices. No women tested positive for COVID-19 during the study period.Conclusions By using quality improvement methodology, we were able to safely and rapidly implement a new care pathway for women at high risk of PTB which was acceptable to patients and staff, and effective in reducing exposure of COVID-19.Data are available on reasonable request.