MatNeoSIP: collaborating to improve maternity and neonatal outcomes post-pandemic

The Health Innovation Network held its fifth Maternity and Neonatal Quality Improvement (QI) Series event: ‘Sustain and Share’ in October 2023. The Maternity & Neonatal Safety Improvement (MatNeoSIP) team at the HIN has been working with trusts across south London, improving clinicians’ working knowledge of quality improvement methodologies and facilitating project work. Our newly appointed MatNeoSIP Lead, Hebe Davies-Colley shares key outcomes and reflections from the event.

The Perinatal Optimisation Workstream is a set of 9 interventions that all maternity and neonatal units nationally are aiming to successfully implement. The workstream aims to reduce the rates of neonatal deaths, stillbirths and brain injuries that occur during or soon after birth by 50% by 2025 and to reduce the national rate of preterm births from 8% to 6% by 2025.

We were delighted to host colleagues from trusts across south London who came together to share their progress towards reducing maternal and neonatal harm ambitions, learn from the last year of collaboration, and collectively look forward to what the perinatal optimisation workstream will bring next. We heard three local project presentations, a reflective fishbowl discussion, and further presentations from our south east and south west London Local Maternity and Neonatal System (LMNS) leads and the National NHS England MatNeoSIP team.

Since the pandemic, many maternity teams have been running on maintenance mode. This event showed us how the tide is starting to turn; now there is an ever-increasing motivation to start improving outcomes and learn from each other in a collaborative, multi-organisational, multi-disciplinary community. It was inspiring to see great successes in several south London trusts, with notable improvements in rates of delayed cord clamping (DCC) and maintenance of normothermia for preterm babies.

DCC is where clamping of the umbilical cord separates the baby and the placenta is delayed 60 seconds after birth. This allows time for extra blood to flow from the placenta to the baby and evidence shows that DCC reduces death in preterm babies by nearly a third. Normothermia is maintaining the normal body temperature which is important because hypothermia (temperature too low) carries risks including sepsis and respiratory distress. At the same time, hyperthermia (temperature too high) can have significant metabolic consequences. DCC and normothermia are 2 of 9 elements measured as part of the perinatal optimisation workstream in the MatNeoSIP.

Dr. Mirna Krishnan, Neonatal Registrar at King’s College Hospital (KCH), gave an excellent overview of their QI project named ‘Optimum Cord Management: “Hurry-up and Wait"’. In a year, KCH successfully increased the rates of DCC for babies under 34 weeks at the Princess Royal University Hospital site and Denmark Hill site by 12% and 27%, respectively. Both sites are achieving 90% documentation of cord management and the rate of DCC is now sitting just below the average across the patient safety collaborative area.

Dr Yogita Shanmugharaj, Neonatal Clinical Fellow at the Queen Elizabeth Hospital site of Lewisham and Greenwich Trusts (LGT) also gave a presentation on optimal cord management titled ‘Improving compliance with Delayed Cord Clamping (DCC) for preterm babies < 34 weeks’. Yogita reported that after 2 improvement cycles to raise staff awareness and introduce measures where basic newborn life support (NLS) was initiated (stimulation and airway support) to the baby to perform a heart rate assessment at 30 seconds while still attached to the cord, the overall rate of DCC increased from 49% to 83%!

Dr. Drupti Jogia Paediatric Registrar and Dr. Alina Petric Paediatric SHO of Croydon University Hospital (CUH) also presented their successful work. They spoke about their audit project entitled ‘Maintaining normothermia on Admission to the Neonatal Unit.” Through implementing a checklist for admission temperature, rates of hypothermia dropped from 32% in Q1 2022/23 down to 4% in Q3.

We then used a “fishbowl” technique to hold a reflective discussion exploring the experiences of those who had participated in the projects at a trust level with engagement from the HIN.

Looking at the factors which made the process work, it was clear that the dedication of the project team and working group members was key. Challenges discussed included trying to sustain the measures to become ‘business-as-usual’ after QI programmes had ended. The participants also discussed difficulties with juggling clinical responsibilities and project work.

Dr Justin Richards, Consultant Neonatologist at St George’s Hospital and south west London (SWL) Neonatal Network Lead presented clear updates from the SWL LMNS workstream. He reported that the appointment of two Neonatal Quality Leads has incurred drastic improvement in the SWL engagement with the perinatal optimisation interventions and therefore steep improvements in the rate of uptake across SWL trusts.

Mel Howie, Maternity Project Manager from the south east London (SEL) LMNS set out SEL priorities for 2024 including a parent passport, integrating neonatal parents into the maternity voices partnership, and further progressing the preterm birth pathways.

Finally, we were pleased to hear from Charlie Merrick, Senior Improvement Manager in the national MatNeoSIP team at NHS England. Charlie provided clear insight using the Preterm Optimisation Dashboard (available on the MatNeoSIP page on FutureNHS) and displayed outcome data of some huge achievements since the start of MatNeoSIP in 2018. These included the potential lives saved, brain injuries prevented and cost savings to welfare and society in south London. Looking forward, MatNeoSIP will have a new ambition for 2024/25 starting next April, the details of which will be confirmed in due course.

I feel that we had an incredibly positive event. It was brilliant to bring our colleagues together celebrate their successes and collaborate in a positive space. Delegates reported that the ‘energy for improvement was palpable’ and a real appetite for change in the south London region. We at the HIN hope to continue providing practical and facilitative support to improvement teams at the trusts, and we’d like you to watch this space for news of our next round of workshops sharing learning about quality control and sustainability of interventions within QI projects so the improvements in practice are maintained.