Abstract
Objective We compare maternal morbidity and clinical care metrics before and after the electronic
implementation of a maternal early warning trigger (MEWT) tool.
Study Design 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.
Results 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, p = 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],
p = 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%, p = 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.
Conclusion 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.
Key Points
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MEWT was not associated with a decrease in maternal morbidity.
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MEWT was associated with improvements in some clinical care metrics.
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MEWT is more sensitive in detecting septic, hypertensive, and cardiopulmonary morbidities
than hemorrhage morbidity.
Keywords
maternal early warning trigger tool - maternal early warning system - maternal morbidity
- maternal mortality
