Improvement Story Nine

Scottish Perinatal Clinical Network 

Contributors: Lesley Jackson, Neonatal Network Lead; Tara Fairley, Obstetric Network Lead; Lena Crichton, Consultant Obstetrician; Julie-Clare Becher, Consultant Neonatologist.  

What aspects of culture did you focus on and what changes did you make?

We focussed on the shared learning and improvements in pathways of care that can be made following establishment of an annual network event to review all ‘Births <27 weeks outside of a NICU setting’. 

LNUs and SCUs are invited to present cases in a structured format to understand best the barriers and challenges that teams face when assessing preterm birth and in arranging transfer for mothers to NICU settings. The outcomes of babies undergoing ex
utero transfer are also discussed.  

This meeting also gives an opportunity to highlight excellent practice undertaken by many teams in acute situations, particular the multidisciplinary collaboration across and within sites to find solutions to try and expedite maternal transfer. 

Themes that have arisen have been severe challenges in staffed capacity; suboptimal triage and pathways; missed opportunities to identify preterm birth; lack of education leading to immediate cord clamping; hypothermia (admission, procedural and transport); need for training around airway support and skin antisepsis; and the need for
support for data collection. 

What effect this has had on your team culture? 

There is an improved sense of sharing responsibility for optimising place of birth with a palpable sense that the Perinatal Clinical Network is seeking to improve pathways, training and support in this area. Development of optimal pathways and provision of support and training for referring units should help to foster a network-wide culture of flattened hierarchies and shared goals among all perinatal clinicians. 

What barriers have you had to overcome? 

The barrier of ‘us’ and ‘them’ is one that has to be carefully navigated along with the barriers that come with virtual meetings. This means that encouraging openness and transparency with sensitive discussion and visible support for referring units is  paramount. We have identified a value in future years in encouraging receiving units to present local cases where perinatal optimisation interventions have not been achieved thereby illustrating a common experience of challenges in this area.

Ensuring engagement across the entire perinatal teams is improving but we seek greater attendance from maternity teams in years ahead. 

What helped to make this successful? 

The Network taking a lead in this area was essential. Joint chairing between obstetricians and neonatologists reinforces perinatal teamworking but could yet be improved by ensuring referring unit representation as chairs. Having a standard format for presentation ensures the right detail is collected and presented. Ensuring that actions from previous years, such as the development of an exception reporting tool (based on the BAPM Antenatal Optimisation Toolkit), are progressed and disseminated to teams is important in maintaining engagement with the process.