COVID-19 and maternity care in South East London: shared working and learning initiative

Abstract

The SARS-CoV-2 COVID-19 pandemic has had an immediate and profound impact on how healthcare systems organise and deliver services and specifically, there is a disproportionate negative impact on Black, Asian and Minority Ethnic groups and other risk factors. This has required clinical leaders to respond at pace to meet patient’s care needs, while supporting staff working in a volatile, uncertain, complex and ambiguous environment. During the initial wave and then the later waves within our South East London sector, there were new challenges as everyone faced a novel disease necessitating real-time learning and reflection. Through informal conversations and networks, the clinicians highlighted in the first wave the need for a forum for clinical discussion. Using our existing South East London Local Maternity System and the evolving Maternal Medicine Networks alliance, we initiated a sharing and learning platform to support clinical decision-making for all maternity health professionals during the pandemic. Fortnightly, multidisciplinary virtual huddles were established allowing obstetric physicians, obstetricians, midwives and obstetric anaesthetists to share their clinical experience, operational and service challenges. This approach fostered and developed cross-site team working and shared learning across traditional, organisational boundaries. In South East London, prior to the introduction of universal testing in the first surge, we had a total of 65 confirmed positive cases of which 5 women were delivered due to COVID-19, 5 women required high dependency or intensive care and 3 women were intubated and ventilated. During the second and third waves, the COVID-19 Local Maternity System huddles provided monthly learning opportunities to share clinical practice, guidelines, vaccination updates and challenges with workforce. The huddles have proven to be a sustainable platform, which have built trust across the sector, facilitating effective teamwork and providing invaluable support for clinical decision-making. We describe the evolution of this structure and share our experience of working within this new clinical network during the first wave and how this established way of working facilitated collaboration during the second and third waves as staff and the system became more fatigued. The huddles have developed to become multi-professional, multisite collaborations with the whole group taking joint ownership to develop shared learning and are providing a forum for discussions for the emerging South East London’s Maternal Medicine Network.

Implementation of Public Health England infection prevention and control guidance in maternity units in response to the COVID-19 pandemic

“…Steward et al (2021) [ 20 ] published a quality improvement report which aimed to share and support clinical decision-making for health professionals working in maternity by drawing upon the expertise of obstetric physicians working in South-East London, UK. Aligned with current findings whereby participants highlighted that a multidisciplinary approach allowed for a more successful implementation of PHE guidance, Steward et al (2021) [ 20 ] described that the formation of fortnightly multidisciplinary team virtual huddles with midwives, obstetricians, obstetric physicians, and obstetric anaesthetists allowed individuals to share clinical experiences, and any operational and service challenges. Importantly, these huddles have provided a platform to build trust across the sector by facilitating effective teamwork and supporting clinical decision-making.…”