Digital innovation to help safe postnatal discharges at Chelsea and Westminster

The problem we are trying to solve:

‘No bed at the inn’, or in our case NHS maternity service can adversely impact birth and postbirth outcomes and experiences, of those in need of immediate care. Consequences can include brain injury or death of baby whilst women/birthing people are awaiting appropriate level of labour care. Closure of NHS maternity units is thus a national safety recommendation for the period that an organisation cannot provide the standard of one-to-one midwifery care in labour . After birth, often care is transferred to the postnatal ward. Lack of postnatal beds to support ongoing care can thus create a bottleneck to labour-related admissions and contribute to maternity unit closures. In July 2022, the House of Commons Health and Social Care Committee Report on Workforce: recruitment, training and retention in health and social care , highlighted the unsustainable pressure NHS maternity services are under.

On 21st September 2022, NHS England set out essential and immediate changes to the Midwifery Continuity of Carer national programme recognising the continued midwifery workforce challenges . Whilst NHS staff shortages are addressed, there is an urgency to deliver a value-based maternity service, which also supports the people providing care. Our innovation aims to achieve this for postnatal care and can be extrapolated to other services

The size of the opportunity

Giving birth is the commonest reason for admission to the hospital, with 559,728 births occurring in NHS hospitals in 2020-21. Care Quality Commission (CQC) Survey of NHS Maternity Services (2019)4 confirms that 44% of survey respondents reported a delay on the day of discharge from the postnatal ward. Extrapolating this response to the 2020-21 NHS births means that up to 246,280 women may have experienced a delay in discharge from the NHS postnatal ward.

Each added hour of delay in discharge from postnatal ward represents inappropriate use of limited NHS resources and an opportunity for improvement. Ensuring safe and timely postnatal discharges can thus help reduce the total of 16,294 hours or equivalent of 679 days when NHS maternity units had to stay closed in 2020-215 and optimise the value of NHS maternity bed pool of 7,6666 .

Uniqueness of postnatal care

Unlike other hospital-based services, postnatal ward provides simultaneous support for the mother and baby (ies) with up to 14 different team members being involved. Ongoing care is then transferred to community teams, who may or may belong to the similar catchment area as the maternity service provider. Clinical significance of postnatal care

• A mother’s risk of dying is highest in the period after the birth, and the risk extends to up to a year after the birth

• For baby, the first 1001 days represents a critical period to lay foundations for lifelong emotional and physical wellbeing

With shortening length of hospital stay, ward processes must be safe, operationally effective, and supportive to women/birthing person, families, and all team members.

Progress to date

In December 2018, Chelsea and Westminster Hospital launched a be-spoke postnatal digital dashboard compliant with NHS information governance and operational standards. For the first time, mother and baby care and all team members were joined up. Traffic-light system is displayed on the ward TV and available from any Trust device with easy access to operational information for individual tasks, estimated discharge dates and factors influencing it.

Please see the attachment for more information about the innovation and results