You may have seen our recent blog post sharing best practice in antenatal sickle cell and thalassaemia screening. This follow-up article gives a great account of how one local area has been making improvements.
As a screening and immunisation coordinator, one of the main aspects of my role involves commissioning safe, high quality antenatal and newborn screening programmes.
The team I work in supports local providers across Essex and encourages them where standards are not being met. We like to think creatively to drive continual improvement and reduce screening inequalities.
Several years ago, alongside one of our local trust’s antenatal and newborn screening teams, we worked to increase the number of women having screening bloods taken within 10 weeks of pregnancy in one hospital.
In April 2014, 37.3% of pregnant women had their screening bloods taken within 10 weeks at the Princess Alexandra Hospital in Harlow. The trust reached the acceptable standard of 50% the following year and the number of women having bloods taken within 10 weeks has continued to rise since.
In this blog I'd like to tell you a little bit about how these improvements were made.
How we did it
It is important that bloods for sickle cell and thalassaemia screening are taken no later than 10 weeks into pregnancy so women who screen positive are given time to think about their options.
Discussions started in December 2014 to improve turnaround times at the Princess Alexandra Hospital when the trust’s screening coordinator audited which women were late bookers and therefore having bloods taken later in pregnancy.
It was identified that the majority of these women were ‘out of area’, which meant although they technically lived within an area served by another trust they had chosen to have their baby at Princess Alexandra Hospital for a variety of reasons, perhaps because of transport links.
We mapped the screening pathway to identify where the delays were and found that many were happening because the women were not being booked for maternity care by the trust where they would give birth. As a result, paperwork was being posted between teams which was adding time to the process.
After discussion, the trust began to bring the ‘out of area’ women back in-house for booking appointments. All women who are going to give birth at the trust now have their booking appointment and screening bloods taken with a trust midwife.
Getting the messaging right
Awareness was raised within the trust to ensure that any woman who may not have had screening bloods taken were directed to the screening team.
The trust and the screening and immunisation team circulated letters, bulletins and posters to raise awareness among GPs that women can self-refer to maternity services. The local Clinical Commissioning Group (CCG) helped spread the message to GPs and included information on their social media pages.
It was important that the trust website allows women to book directly with the maternity service and that it is easy to navigate. Changes were made to ensure this.
More recently we were able to secure funding from NHS England to run an ‘early maternity booking’ social media campaign. This included adverts targeted at women of childbearing age in the Essex area on Facebook and Instagram. The adverts encourage women to book directly with their local maternity services and had links to take them to the right place to arrange their booking.
The trust achieved 77.9% of women having their screening bloods taken within 10 weeks in quarter 3 of 2018 to 2019. They have now set themselves a local target to meet 80% within the next year.
This shows that if we work together then it's possible to make real service improvements for the people we serve. Although these may take time, performance can be greatly improved and women can get more timely care.
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