Workshop 1 - Report IMPS IMproving Care in a Pregnancy after Stillbirth Central Manchester University Hospitals NHSFT University Hospital of South Manchester NHS FT

IMPS Dr Alexander Heazell – Senior Clinical Lecturer in Obstetrics, UoM / CMFT Dr Clare Tower – Clinical Director of Obstetrics, St Mary’s Hospital, CMFT Ms Louise Stephens – Specialist Research Midwife, CMFT Ms Christine Navin – Specialist Bereavement Midwife, UHSM Dr Sreebala Sripada – Consultant Obstetrician, UHSM

What are we trying to accomplish? To improve antenatal care for parents who have experienced a stillbirth in a previous pregnancy by establishing a specialist service within 12 months. Apply a service model developed in a tertiary service (with additional funding) to antenatal care in a secondary care to improve service for parents who have previously experienced a stillbirh.

Reason for the effort Why is the effort important? – Manchester Academic Health Science Centre have target to reduce preventable stillbirth by 50% by DH also made commitment to halve stillbirth by – Women who have had a stillbirth have 5x increased risk of stillbirth in a subsequent pregnancy and increased risk of other pregnancy complications. – Families embarking on another pregnancy have psychological and social needs that are not met by standard antenatal care. How will this improvement benefit the organisation? – By helping it meet the target of stillbirth reduction and improving antenatal care.

Reason for the effort What are the potential negative consequences? – Resource use – Opportunity cost - staff time may be better spent on other ventures – Increased intervention What data/analysis supports the choice? – Number of families using the service – Access to relevant interventions – Satisfaction / Patient experience – Pregnancy outcome

Reason for the effort How does it impact patients? – Changes structure of care – Access to novel investigations / additional expertise – Potential to improve care Who is your team sponsor? – Prof. Colin Sibley – Director of Research, Manchester Academic Health Science Centre

Expected Outcomes Primary Outcome - Establish a sustainable Rainbow Clinic at UHSM in 12 months; Develop guideline for the care of women with previous stillbirth at UHSM; Develop processes to encourage appropriate families to attend Rainbow Clinic at UHSM; Develop process indicators and outcome indicators to assess change; Develop tools for data collection; Engage staff at UHSM in the initiative.

How do we know change is an improvement? Process Outcomes Number of families using the Rainbow Clinic at UHSM; % of women with a history of stillbirth seen in the Rainbow Clinic at UHSM; Number of antenatal attendances in women attending the Rainbow Clinic at UHSM; % women accessing relevant interventions (smoking cessation, Aspirin); Clinical Outcomes Patient experience of women/families seen in Rainbow Clinic at UHSM; Stillbirth rate in women who attend Rainbow Clinic at UHSM; Preterm birth rate in women who attend Rainbow Clinic at UHSM; Frequency of other pregnancy complications in women who attend Rainbow Clinic at UHSM; Induction of labour rate / Caesarean section rate in women who attend Rainbow Clinic at UHSM (compared to the main population).

What changes can you make? Initial Changes Establish clinical service at UHSM with appropriate links to CMFT. Develop clinical guidelines. Ensure outcome measures are appropriate. Ensure systems and ethical approvals in place to collect data. Boundaries Financial envelope – MAHSC grant to deliver the Rainbow Clinic at UHSM (to be maintained needs to be deliverable within the NHS maternity tariff). Governance – must meet established antenatal care guidelines from NICE. Legal constraints e.g. Data transfer between sites

Driver Diagram Please provide a rough first draft of your driver diagram We will cover how to use this tool in detail during the first workshop – this representation can be a very early first draft On the next slide you can find a template which you may find useful

Establish a sustainable Rainbow Clinic at UHSM in 12 months Define Service Components Evaluate Service Model Deliver Service Model Use existing models Write guidelines Ask patients Search literature CMFT clinic Make a team Obtain referrals Identify team Obtain funding Engage local support groups Advertise to CMWs / GPs Identify patients Posters/Fliers Launch event Team identity / logo Training needs Data available Extra data needed Financial Information Collect and analyse data

Key activity Project assessment score ( ) (see next slide for criteria) MayJunJulAugSepOctNovDecJanFebMarApr Score1.5