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7: Use of maternal early warning trigger (MEWT) tool reduces maternal morbidity

      Objective

      To determine if implementation of a MEWT tool can reduce maternal morbidity.

      Study Design

      A previously published internally developed MEWT tool was prospectively applied to 6 pilot sites in a large system with 29 maternity units. The tool’s primary goal is timely assessment and management of patients suspected of clinical deterioration. The tool addresses 4 areas: sepsis, cardiopulmonary dysfunction, hypertension, and hemorrhage (HEM). Triggers sustained for >30 min were defined as SEVERE (required 1 abnl value): HR>130 bpm, RR>30/min., MAP<55 mmHg, O2 saturation<90%, nurse concern or NON-SEVERE (required 2 abnl values): Temp>38 or <360C, BP>155/105 mmHg or <85/45 mmHg, HR>110 or <50 bpm, RR>24 or <10/min, O2 sat<93%, FHR>160 bpm, altered mental status, and disproportionate pain. Outcome measures were sepsis, HEM, transfusion(TX), hysterectomy(HYS), eclampsia, composite morbidity(CM), severe maternal morbidity(SMM) and ICU transfer. Two periods were analyzed: 24 months pre-MEWT and 11 months post-MEWT. Data analyzed using z-ratios for significant difference between two independent proportions. Non-Pilot sites were evaluated to determine similarities or differences between Pilot MEWT and Non-Pilot sites.

      Results

      Use of MEWT tool resulted in significant reductions in CM, eclampsia, and use of D&C. As desired, sepsis identification and ICU transfers increased. HYS, HEM, TX and SMM declined non-significantly post-MEWT. At Non-Pilot sites CM significantly increased. In Non-Pilot sites all outcome parameters trended towards worse maternal morbidity except eclampsia; data outlined in Table 1.

      Conclusion

      MEWT tool use resulted in significant improvement in maternal morbidity. At MEWT sites, individual outcomes moved in the desired direction towards reduced maternal morbidity. These findings were in contrast to a background of significantly worse maternal outcomes at sites not using MEWT. The pilot hospitals births vary from 900 to 3000 annually, suggesting this method may be transferable to maternity centers across the U.S.
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