Department of Anaesthesia Poole Hospital NHS Trust Longfleet Road Poole Dorset BH15 2JB

18th April 2007

To : All Clinical Leads in Obstetric Anaesthesia

Dear Colleague,

The last triennial CEMACH report recommended the introduction of an Early Warning Scoring System (EWS) in obstetrics to allow the early detection of clinical deterioration of patients. We are not aware of any validated obstetric EWS and would like to try and find out if any such system exists in the UK and perhaps to suggest an EWS based on modification of those already in use for the non-obstetric population.

Current evidence suggests that the majority of admissions to critical care for obstetric patients are due to hypertensive disease or haemorrhage. We have attempted to adapt our local non-obstetric EWS to take into account the physiological changes of pregnancy.

We are extremely interested in your views and comments with regard to obstetric early waning systems as a whole, and would be very grateful if you would spare a few moments of your time to consider the enclosed questionnaire.

When you have completed the questionnaire, please return it in the enclosed stamped address envelope.

Many thanks for your time,

Yours sincerely,

Dr Rob Swanton (SpR, Poole Hospital) Dr Samar Al-Rawi (SpR, Southampton Hospital) Dr Mike Wee (Consultant Anaesthetist & Obstetric Anaesthetic Lead, Poole Hospital)

References 1. Confidential Enquiry into Maternal and Child Health : Why Mothers Die 2000-2002 2. Parissopoulos S, Kotabassaki S. Critical Care Outreach and the use of the Early Warning Scoring Systems – a Literature Review. ICUS Nurs Web J 2005; 21: 1-13 3. Subbe C, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in Medical Admissions. Q J Med 2001; 94: 521-526 4. Goldhill D, McNarry A. Physiological abnormalities in Early Warning Scores are related to mortality in adult inpatients. Br J Anaesth 2004; 92(6): 882-884 5. Mirghani H, Hamed M, Ezimokhai M, Weerasinghe D. Pregnancy-related admissions to the Intensive Care Unit. Int J Obst Anaesth 2004; 13: 82-85 6. Demirkiran O, Dikmen Y, Utku T, Urkmez S. Critically ill obstetric patients in the Intensive Care Unit. Int J Obst Anaesth 2003; 12: 266-270 7. Okafor U, Aniebue U. Admission pattern and outcome in critical care obstetric patients. Int J Obst Anaesth 2004; 13: 164-166 8. Gopalan PD. The critically ill obstetric patient – what’s the score? – Editorial. Int J Obst Anaesth 2004; 13: 144-145 9. Harrison D, Penny J, Yentis S, Fayek S, Brady A. Case mix, outcome and activity for obstetric admissions to adult, general critical care unit – secondary analysis of the ICNARC Case Mix Programme Database. Critical Care 2005; 9(suppl 3): S25-S37 This survey has the OAA ‘Seal of Approval’ Survey No: 76 approved October 2007

OBSTETRIC EARLY WARNING SCORING SYSTEM SURVEY

Many thanks for taking the time to fill out this short questionnaire. We are interested in your comments with a view to implementing an Early Warning Scoring System for obstetric patients as recommended by the recent CEMACH report. Please circle answers to the following questions as appropriate.

1) What type of maternity unit do you work in?

DGH Tertiary Referral

2) How many deliveries does your unit perform per year?

<2000 2000-3000 3000-4000 >4000

3) Do you have a separate HDU/ICU facility for obstetric patients?

Yes No

If Yes, approximately how many HDU/ICU admissions per year? ______

4) Does your unit already run an Obstetric Early Warning Scoring System?

Yes No

If Yes, please provide brief details and include a copy of the system with the completed questionnaire.

………………………………………………………………………

5) Do you think an Obstetric Early Warning System would be of use in your unit? (0=no use, 5=very useful)

0 1 2 3 4 5

6) Do you think it would be possible to implement such a system in your unit?

Yes No

7) Does your hospital currently run an Early Warning Scoring System for the non-obstetric population?

Yes No Don’t Know

If Yes, has it been shown to have a positive effect?

Yes No Don’t Know

8) In view of the normal changes in physiology of the pregnant patient, do you think a non-obstetric early warning score is applicable when recognising the deteriorating patient in an obstetric unit?

Yes No Maybe

9) Any other comments?

…………………………………………………………………………………………

…………………………………………………………………………………………..

Many thanks for taking the time to complete this survey. Please insert your completed questionnaire into the stamped addressed envelope.

Dr Rob Swanton (SpR in Poole Hospital) Dr Samar al-Rawi (SpR in Southampton Hospital) Dr Mike Wee (Consultant Anaesthetist and Obstetric Clinical Lead, Poole Hospital)