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The effects of merging maternity units on critical care admissions – our 2 year experience
  1. C Aye,
  2. P Patel,
  3. A Burumdayal,
  4. V Miller,
  5. V S McNeillis
  1. Stoke Mandeville Hospital, Aylesbury, UK

Abstract

Background Lord Darzi's review into the NHS in 2008 recommended that specialist obstetric services should be concentrated in larger centres to provide better care for high risk women.1 This resulted in the amalgamation of maternity units including in Buckinghamshire where the department in Wycombe General merged with that of Stoke Mandeville Hospital in 2009.2 A close observation bay was also created on the labour ward with the aim of reducing the number of admissions to critical care.

Study objective To assess whether these changes decreased the number of admissions to critical care.

Method A retrospective analysis of all admissions to critical care in the 1 year period immediately before and after the merger (October 2008 to October 2010), looking into the reasons, level of support required and length of stay.

Results and discussion Prior to the merger, 16 admissions in the immediate postpartum period were identified compared to 10 the year after. The most common reason was postpartum haemorrhage, which accounted for around half of all admissions both pre and post merge. The average length of stay before the amalgamation was 33 h with 25% requiring level 3 care. This compared to 44 h and 40% requiring level 3 care after the merger. In addition, there were no admissions for level 1 care after the creation of the observation bay. We postulate that this suggests that the new, larger unit results in better management of patients and that only appropriate transfers of the very sick are made to critical care.

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