Managing Serious Complications in Maternity and Acute Medicine

Project Lead: Nicola Mackintosh

Programme Director: Professor Jane Sandall

Aims

• To address how communication affects processes of consultation, referral, and transfer with implications for patient safety and quality of care (with a focus on the management of serious complications in maternity and medical care).
• Discover more about staff, patients’ and their close relatives’ experiences of the management of complications / emergencies.
• Reflect with midwives, nurses and doctors on decisions made about patients who are experiencing complications to gain further understanding about the communication and management during these episodes.
• Review clinical records to collect additional information about these episodes.
• Explore the organisational context of specific communication tools and strategies designed to help detect early signs of complications and management of these situations.

Why is this important?

The journey for childbearing women and patients through the health care system can be problematic, particularly when it involves a number of different organisations and professionals; failures in referral, handover and transfer have been regularly documented. The management of complications in healthcare follows a complex pathway involving detection, assessment and referral response and appropriate action.

Structured communication tools are designed to give nurses or midwives the authority to demand a review from the medical team. Work will include gathering information about how staff react to and deal with emergencies, the role of patients and relatives and assessing whether the communication tool helps this process.

Participants

Managers, doctors, midwives, nurses and support staff will be interviewed to find out how they detect and deal with emergencies. We will also be observing midwives, nurses and doctors working together and making decisions about patients whose conditions may be deteriorating. Importantly, we will be inviting women and their birth partners from maternity services, and patients and their close relatives from the selected acute medical wards who have experienced unexpected complications to participate in the interviews as little research has been done in this area.

Research will be carried out in the delivery suite and one acute medical ward in two different London NHS Foundation Trusts.

Anticipated outcomes

• Add to the limited research that currently exists on how staff deal with complications and emergencies.
• By learning more about the implementation of structured communication tools there may be an opportunity to refine and develop this as an intervention to improve the  management of complications and emergencies.
• Data collection and analysis has taken place, with roll-out and testing of intervention planned for 2011.