Improved maternal–fetal outcomes among emergency obstetric referrals following phone call communication at a teaching hospital in south western Uganda: a quasi-experimental study

Abstract

Background Emergency obstetric referrals develop adverse maternal–fetal outcomes partly due to delays in offering appropriate care at referral hospitals especially in resource limited settings. Referral hospitals do not get prior communication of incoming referrals leading to inadequate preparedness and delays of care. Phone based innovations may bridge such communication challenges. We investigated effect of a phone call communication prior to referral of mothers in labour as intervention to reduce preparation delays and improve maternal–fetal outcome at a referral hospital in a resource limited setting. Methods This was a quasi-experimental study with non-equivalent control group conducted at Mbarara Regional Referral Hospital (MRRH) in South Western Uganda from September 2020 to March 2021. Adverse maternal–fetal outcomes included: early neonatal death, fresh still birth, obstructed labour, ruptured uterus, maternal sepsis, low Apgar score, admission to neonatal ICU and hysterectomy. Exposure variable for intervention group was a phone call prior maternal referral from a lower health facility. We compared distribution of clinical characteristics and adverse maternal–fetal outcomes between intervention and control groups using Chi square or Fisher’s exact test. We performed logistic regression to assess association between independent variables and adverse maternal–fetal outcomes. Results We enrolled 177 participants: 75 in intervention group and 102 in control group. Participants had similar demographic characteristics. Three quarters (75.0%) of participants in control group delayed on admission waiting bench of MRRH compared to (40.0%) in intervention group [p = < 0.001]. There were significantly more adverse maternal–fetal outcomes in control group than intervention group (obstructed labour [p = 0.026], low Apgar score [p = 0.013] and admission to neonatal high dependency unit [p = < 0.001]). The phone call intervention was protective against adverse maternal–fetal outcome [aOR = 0.22; 95%CI: 0.09—0.44, p = 0.001]. Conclusion The phone call intervention resulted in reduced delay to patient admission at a tertiary referral hospital in a resource limited setting, and is protective against adverse maternal–fetal outcomes. Incorporating the phone call communication intervention in the routine practice of emergency obstetric referrals from lower health facilities to regional referral hospitals may reduce both maternal and fetal morbidities. Trial registration Pan African Clinical Trial Registry PACTR20200686885039.

Acceptability of Phone-Based Communication Intervention by Healthcare Workers as an Adjunct to Routine Referral Form: A Qualitative Study in South Western Uganda

“…This was true as evidenced by the experimental study findings. The intervention reduced patient waiting time on the admission bench and we observed that there was less adverse maternal-fetal outcomes in the intervention group compared to the control group [9].…”

“…The control group was composed of emergency maternal referrals from a similar health centre IV (Kabuyanda HCIV) in the same district (Isingiro district) utilizing only the referral forms, which is the standard-of-care. No phone call was made for the referrals from the control group [9].…”

“…This experimental study investigated the effect of a phone call communication prior to referral of mothers in labour as an intervention to reduce preparation delays and improve maternal-fetal outcome at a referral hospital (MRRH). The phone-based interven-Open Journal of Preventive Medicine tion was also used to give feedback from MRRH to Rwekubo HCIV [9]. However, acceptability of this intervention had not been assessed.…”

Global Emergency Medicine: A Scoping Review of the Literature from 2022

“…Yet it is sometimes the most basic interventions, such as providing receiving hospital midwives with a mobile phone rather than paper transfer forms, that may show the most significant impact. In a study conducted in Uganda by Kanyesigye et al., 53 significantly fewer adverse maternal and fetal outcomes were found in a group that received mobile phone–based versus nonverbal handoff of care. Li et al 54 .…”

“I was scared of the operation:” Qualitative study exploring the perceptions and experiences of women referred following obstetric complications in a Regional Referral Hospital in Eastern Uganda

“…Women were surprised to receive respectful maternity care in the referral facility contrary to rumors of prevalent mistreatment in the referral hospital. The availability of functional CEMOC services and respectful maternity care boosts con dence in the referral facility and results in positive birth outcomes (5,11).…”