Issue link: https://maltatoday.uberflip.com/i/1523374
4 maltatoday | SUNDAY • 30 JUNE 2024 NEWS CONTINUED FROM PAGE 1 The researchers said that with limited number of deliv- ery rooms at MDH, a materni- ty unit triage room could allow for better utilisation of labour wards and resources being used for those most in need. Most maternity units in the UK already have a materni- ty triage room, where all in- coming pregnant women with acute presentations are as- sessed, as well as telephone re- ferrals, and where blood tests or internal examinations can take place if required. The quantitative analysis of 490 women admitted at the MDH central delivery suite took place over four weeks, where researchers analysed data from all admissions, which included women with different acute presentations – contractions, decreased foe- tal movements, bleeding per vagina, high blood pressure, or spontaneous rupture of mem- branes (SROM), as well as oth- er accidents, or itching, vomit- ing and diarrhoea. Women who had a planned lower-section caesarean sec- tion (LSCS) or induction of la- bour (IOL) – 122 patients (or 25%) – were excluded from the audit. 366 patients (75%) present- ed to the labour ward with an acute complaint. Of these, 224 patients (61.2%) were admit- ted, and 142 patients (38.8%) were discharged after review by basic specialist trainee. Out of the 224 patients admitted, 171 patients (76.3%) delivered during that admission and 53 patients did not deliver. Currently, there is one ad- mission room at MDH's cen- tral delivery suite which is used to review pregnant wom- en at 22 weeks' gestation or more who self-admit or are referred by the obstetric team either because one is in active labour or needs intrapartum management for pregnan- cy-related complications. Of the 366 admissions with acute presentations, these in- cluded 38.8% with an acute complaint to the labour ward, who were discharged after initial assessments. The vast majority of these women oc- cupied a delivery room which could have been available to women that really needed it. Of the 224 admitted follow- ing an acute presentation, 53 did not deliver but were kept in the room for observation or transferred to an obstet- ric ward. These women were also blocking a delivery bed and could have been managed elsewhere. MDH's central delivery suite is a specialised ward of nine delivery rooms, and an op- erating theatre equipped for caesarean sections and other birth procedures, as well as a neonatal resuscitation room. "It is not just mothers in la- bour who are admitted here, but any expecting mother from 22 weeks' gestation on- wards may be referred for as- sessment and will be reviewed by an obstetric team and dis- charged or admitted as nec- essary," researchers Dr Elaine Camilleri, Dr Sharona Falzon, and Mandy Collict, wrote on The Malta Medical Journal. "Unfortunately, this puts ad- ditional stress on the bed avail- ability and may lead to burn- out of the team members. The various functions of the labour ward demand a sound organi- sational structure to maximise the limited resources available whilst providing the best care. This could be optimised by providing a maternity unit tri- age room prior to admission to Central Delivery Suite." The doctors say that apart from better management of high-dependency beds, a ma- ternity triage system reduces waiting and transfer times, improves patient satisfaction, and reduces unplanned admis- sions or readmissions within the first 48 hours. "Common presentations doc- umented in this audit could have been handled in a mater- nity triage room. Most of the presentations were of low acu- ity. 38.8% of acute presenta- tions did not need an admis- sion and were discharged after initial review… "Also, 23.7% of the admit- ted women following an acute presentation did not deliver. These women could have been directed directly to an obstet- ric ward instead of occupying a room in the delivery suite for their assessment. This means that 53.3% of women in this audit who had an unplanned admission to the labour ward could have been handled in a maternity triage room and did not need to block a bed in the labour ward. "If MDH had this system we would be using our limited de- livery room beds better." However, the researchers be- lieve that one triage room may not be sufficient, due to simul- taneous admissions, which are a common occurrence. The doctors say patients inflow can be reduced with a proper telephone service that allows pregnant women and GPs to phone for queries, with mid- wives and obstetricians re- directing non-urgent cases – such as vaginal spotting or minor trauma – which are the majority of the acute presenta- tions. "One must also ensure that an efficient triage system is in place. Midwives should be trained properly in triaging and a doctor, ideally senior, should be present at triage to evaluate the situation upon encounter and treat immedi- ately without any delays. "A fast-track system should be in place. Patients that have low acuity presentations should be assessed in one room by a team of midwives that when necessary involve an obstetrician." The commonest acute pres- entation to the labour ward were contractions, which was documented 131 times. 76.3% of the time, women were ad- mitted. The remaining 23.7% occu- pied a bed in the labour ward for initial assessment and were then discharged home. FOR SALE QUAD BIKE BOMBARDIER 650CC (2006). My black and yellow beautiful almost immaculate, always serviced quad is, with a heavy heart for sale. She is licensed till October 2024 and road ready. It's now time for someone else to enjoy. Annual road is €259. Asking price is €3500. Call or WhatsApp on 79990807. Call for maternity triage room to assess incoming pregnant women with acute presentations The maternity ward at Mater Dei Hospital