Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California.
Department of Obstetrics and Gynecology, Long Beach Memorial Miller Children's and Women's Hospital, Long Beach, California.
Am J Perinatol. 2021 Jul;38(9):869-879. doi: 10.1055/s-0040-1721715. Epub 2020 Dec 27.
We compare maternal morbidity and clinical care metrics before and after the electronic implementation of a maternal early warning trigger (MEWT) tool.
This is a study of maternal morbidity and clinical care within three linked hospitals comparing 1 year before and after electronic MEWT implementation. We compare severe maternal morbidity overall as well as within the subcategories of hemorrhage, hypertension, cardiopulmonary, and sepsis in addition to relevant process metrics in each category. We describe the MEWT trigger rate in addition to MEWT sensitivity and specificity for morbidity overall and by morbidity type.
The morbidity rate ratio increased from 1.6 per 100 deliveries in the pre-MEWT period to 2.06 per 100 deliveries in the post-MEWT period (incidence rate ratio = 1.28, = 0.018); however, in cases of septic morbidity, time to appropriate antibiotics decreased (pre-MEWT: 1.87 hours [1.11-2.63] vs. post-MEWT: 0.75 hours [0.31-1.19], = 0.036) and in cases of hypertensive morbidity, the proportion of cases treated with appropriate antihypertensive medication within 60 minutes improved (pre-MEWT: 62% vs. post-MEWT: 83%, = 0.040). The MEWT trigger rate was 2.3%, ranging from 0.8% in the less acute centers to 2.9% in our tertiary center. The MEWT sensitivity for morbidity overall was 50%; detection of hemorrhage morbidity was lowest (30%); however, it ranged between 69% for septic morbidity, 74% for cardiopulmonary morbidity, and 82% for cases of hypertensive morbidity.
Overall, maternal morbidity did not decrease after implementation of the MEWT system; however, important clinical metrics such as time to antibiotics and antihypertensive care improved. We suspect increased morbidity was related to annual variation and unexpected lower morbidity in the pre-MEWT comparison year. Because MEWT sensitivity for hemorrhage was low, and because hemorrhage dominates administrative metrics of morbidity, process metrics around sepsis, hypertension, and cardiopulmonary morbidity are important to track as markers of MEWT efficacy.
· MEWT was not associated with a decrease in maternal morbidity.. · MEWT was associated with improvements in some clinical care metrics.. · MEWT is more sensitive in detecting septic, hypertensive, and cardiopulmonary morbidities than hemorrhage morbidity..
我们比较了电子实施产妇早期预警触发（MEWT）工具前后产妇发病率和临床护理指标。
这是一项在三家连锁医院内进行的产妇发病率和临床护理研究，比较了电子 MEWT 实施前后一年的数据。我们比较了总体严重产妇发病率以及子分类为出血、高血压、心肺和败血症的发病率，并比较了每个类别中的相关过程指标。我们描述了 MEWT 触发率以及 MEWT 对整体发病率和发病率类型的敏感性和特异性。
在 MEWT 前时期，发病率比率从每 100 次分娩 1.6 增加到 MEWT 后时期的每 100 次分娩 2.06（发病率比率=1.28， =0.018）；然而，在败血症发病率的情况下，抗生素使用时间缩短（MEWT 前时期：1.87 小时[1.11-2.63] vs. MEWT 后时期：0.75 小时[0.31-1.19]， =0.036），在高血压发病率的情况下，在 60 分钟内接受适当降压药物治疗的病例比例增加（MEWT 前时期：62% vs. MEWT 后时期：83%， =0.040）。MEWT 触发率为 2.3%，范围从较不紧急的中心的 0.8%到我们的三级中心的 2.9%。MEWT 对整体发病率的敏感性为 50%；对出血发病率的检测最低（30%）；然而，对败血症发病率的检测为 69%，对心肺发病率的检测为 74%，对高血压发病率的检测为 82%。
总体而言，实施 MEWT 系统后产妇发病率并未降低；然而，重要的临床指标，如抗生素使用时间和降压治疗时间得到改善。我们怀疑发病率增加与年度变化以及 MEWT 前比较年度意外降低有关。由于 MEWT 对出血的敏感性较低，并且出血主导着发病率的管理指标，因此，检测败血症、高血压和心肺发病率的过程指标是跟踪 MEWT 疗效的重要指标。
· MEWT 与产妇发病率降低无关。
· MEWT 与一些临床护理指标的改善有关。
· MEWT 在检测败血症、高血压和心肺发病率方面比出血发病率更敏感。
