A national cross sectional survey of heads of midwifery services of uptake, benefits and barriers to use of obstetric early warning systems (EWS) by midwives.

OBJECTIVE: to identify the extent to which Early Warning Systems (EWS) are used by midwives in the United Kingdom (UK), the maternity settings they are used in, physiological parameters used to 'trigger' referral, training provision, barriers to implementation and role in preventing maternal morbidity. DESIGN: cross-sectional survey of heads of midwifery services. An email questionnaire was sent in September 2012. SETTING: UK NHS secondary care organisations providing maternity care. FINDINGS: heads of midwifery from 107 (68%) of 157 NHS organisations responded, with 108 questionnaires returned as two organisations had recently merged. All organisations, apart from one which only had a free-standing midwifery unit, had introduced EWS. Nearly all respondents (99%) reported EWS were used by midwives antenatally, 76% in labour and 100% on the postnatal ward. All EWS charts included body temperature, heart rate, respiratory rate, systolic blood pressure and oxygen saturation although parameters for escalation varied widely. Barriers to use of EWS by midwives included overlap with the partogram in labour, and staff shortages and delays obtaining clinical review when referral was triggered. Two-thirds considered EWS prevented maternal morbidity although few could provide supporting evidence, for example, audit findings. Training for midwives in use of EWS was available in 83% of organisations. CONCLUSION: most UK midwives are using EWS, with the highest use in obstetric units. The heterogeneity of EWS currently used potentially limits collation of evidence to inform appropriate system level responses. Research is needed to evaluate the role of EWS to prevent maternal morbidity during and after pregnancy in different maternity settings.

Intensive care requirements for an ageing population--a microcosm of problems facing the NHS?

The changing patterns of admissions to an intensive care unit (ICU) were investigated in relation to age. The local population and the patients admitted to ICU in each year from 1996 to 2002 were stratified by age. The trend in the ratio of admissions to population showed the most extreme changes in those aged > or = 60 years. For this group, there was an increase of 2.62 admissions per 10,000 population per year (95% Confidence interval (CI) 1.41 to 3.85, p = 0.004). APACHE II (Acute Physiology and Chronic Health Evaluation II) scores increased by 0.45 points per year (95% CI 0.16 to 0.74, p = 0.013) and length of ICU stay increased by 0.21 days per year (95% CI 0.03 to 0.38, p = 0.032). This rapid increase in the use of ICU resources by patients aged > or = 60 years over a period of six years, combined with an ageing population, suggests that current projections of future ICU provision may be inadequate.