238: Maternal Early Warning Trigger tool improves clinical care in large community hospital system

Abstract

We compare maternal morbidity and clinical care metrics before and after implementation of a maternal early warning trigger (MEWT) tool. This is a quasi-experimental study of maternal morbidity and care metrics within three linked hospitals comparing 52 weeks before and 54 weeks after electronic MEWT implementation (encompassing 20,000 pregnancy encounters). We compare severe maternal morbidity overall as well as within the subcategories of hemorrhage, hypertension, cardiopulmonary and sepsis in addition to relevant process metrics. We describe the MEWT trigger rate in addition to MEWT sensitivity and specificity for morbidity overall and by morbidity type. The morbidity rate ratio increased from 1.6 per 100 deliveries in the pre MEWT period to 2.06 per 100 deliveries in the post MEWT period (IRR 1.28, p=0.018), however in cases of septic morbidity, time to appropriate antibiotics decreased (pre MEWT: 1.87 hours vs post MEWT: 0.75 hours, p=0.036) and in cases of hypertensive morbidity, care escalation within 60 minutes improved (pre MEWT: 62% vs post MEWT: 83%, p=0.04). In cases of cardiopulmonary morbidity, time from vital sign alteration to diagnostic study or treatment trended down (3.82 hours vs 1.5 hours, p= 0.465). The MEWT trigger rate was 2.3%, ranging from 0.8% in the less acute centers to 2.9% in our tertiary center. MEWT sensitivity for morbidity overall was 50% (if ideally implemented); sensitivity for hemorrhage morbidity was lowest (30%), however ranged between 69% for septic morbidity, 74% for cardiopulmonary morbidity and 82% for cases of hypertensive morbidity. Overall maternal morbidity did not decrease after implementation of MEWT, however several clinical metrics improved. MEWT sensitivity for hemorrhage was low, and because hemorrhage dominates administrative morbidity, clinical metrics around sepsis, hypertension, and cardiopulmonary morbidity are important to track as markers of MEWT efficacy. The electronic implementation of MEWT has unique challenges which affect its performance. Future work will include strategies to improve implementation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)