Answers to frequently asked questions about Tommy’s National Centre for Maternity Improvement
The Tommy’s National Centre for Maternity Improvement has developed an online clinical decision support tool. This tool is an app shared between maternity care professionals and women, to help ensure each woman receives the right care at the right time, and ultimately save more babies’ lives.
By equipping maternity staff to offer the right information at the right time based on best practice recommendations, and supporting women to make informed choices about their personalised care our Centre will help improve maternity care in all UK regions to the level of the top performing 20% of hospitals.
By doing this, we aim to prevent up to 12,000 premature births and 600 stillbirths every year, supporting Government targets to reduce premature birth from 8% to 6% and to halve stillbirth rates by 2025.
Our Centre is funded by Tommy’s Charity and is a collaboration of obstetricians, midwives and women as well as our academic and charitable partners, the Universities of Bristol and Sheffield, St George’s University Hospitals London, King’s College London and the Mothers for Mothers and PROMPT Maternity Foundation charities.
Together we are committed to making UK the safest place in the world to give birth.
Our Centre and the Government are committed to making the UK the safest place in the world to give birth. We know that every healthcare professional wants to provide the best standard of care, but services are often and now more than ever, under-resourced and over-stretched.
With more than 92 separate pieces of national pregnancy-related guidance and advice to follow, each containing numerous recommendations and statements, it is unrealistic to expect midwives and doctors to remember every single one and to apply them in an appropriate and personalised way for each woman.
We also know that not all women receive the right level of care; current risk assessments involve a simple checklist and results can be unreliable. Currently too many women are incorrectly identified as being at high risk of complications, which means that many will receive unnecessary scans and tests. Other women are not identified at risk at all and may experience a loss before being referred for the specialist care they need.
The Tommy’s Clinical Decision Tool aims to support midwives and doctors by making it easier to provide the best standard of care possible and crucially, the right care at the right time to help prevent stillbirths and premature births and the consequential suffering this causes to families. We aim to raise the standard of maternity care in all UK regions to the level of the top performing 20% of hospitals and through this, we believe we can help prevent up to 12,000 premature births and 600 stillbirths every year, supporting Government targets to reduce premature birth from 8% to 6% and halve stillbirth rates by 2025.
The science
The Tommy’s Clinical Decision Tool works by using validated algorithms to more accurately assess a woman’s risk of premature birth and of developing pregnancy complications that can lead to stillbirth.
This includes assessing placental function, to enable early identification when the placenta does not work as it should - this can show as pre-eclampsia or can prevent baby growing properly. Early identification and intervention will help to reduce the potential adverse outcomes in this situation.
It does this by using information already gathered by midwives and doctors during maternity care, and pushing this information through the algorithms to provide personalised care recommendations. These care recommendations are based on a more accurate assessment of risk and are in line with best practice maternity care and evidence-based national clinical guidelines. This will help to ensure every woman receives the right care at the right time, no matter where she lives.
The decision support
The Tommy’s Clinical Decision Tool enables maternity care professionals and women to access the right information at the right time.
It does this by providing continuity of care information throughout maternity care.
The app’s algorithms work to generate the right information and recommendations at the right time, using all the information inputted to the app at multiple maternity appointments.
This means that instead of sifting through pages of paper or digital notes, we can see the right information at the right time to support women in making informed decisions about their personalised care.
Information and resources hub
Our app also includes an information and resources hub linking to key maternity information provided by the NHS, the RCOG, the RCM and Tommy’s Charity. It will:
- provide links to information relevant to stage of pregnancy throughout maternity care
- provide specific advice on what a woman can do if she experiences any pain or bleeding during pregnancy or if she notices changes in baby’s movement
No. The tool will reduce the burden on midwives and the wider maternity care team including sonographers.
We know that current risk assessments can be unreliable. Our app will more accurately assess and identify those women who need closer monitoring and de-escalate those who can continue on the standard maternity care pathway. It does this by working the routinely gathered information harder through the use of algorithms that are validated for use in clinical care. There are no additional inputs that require to be entered by midwives.
Crucially, our app has been developed by healthcare professionals and women together, for healthcare professionals and women. Our development team, in close consultation with the very people who will use the app has worked hard to ensure that inputs and functionality are simple and effective and that guidance and recommendations are accessible in any situation.
Our maternity care professionals will be able to better balance their time, whilst ensuring that each woman is receiving the right care at the right time.
In some cases, we do not know why premature birth and stillbirth occurs, but we do understand some of the factors that can increase the risk of these happening. This means we can take steps to reduce these risks.
For example, we know that problems with the placenta can lead to stillbirth. This is when the placenta does not work as it should and can show as pre-eclampsia or prevent baby growing. Early identification and intervention can help to prevent the potential adverse outcomes in this situation.
As you would expect, we are taking a staged approach to implementing the app widely in NHS. Version one of our app will be implemented in four NHS Trusts from Summer 2021 – this forms our ‘practical implementation and evaluation study’.
- 2020/21: Development and testing
- 2021/22: Practical implementation and evaluation study
- 2022/23: Randomised step-wedge cluster trial
- 2024: National rollout
This staged approach allows us to:
- evaluate usability for maternity care professionals and for women to ensure any learning from our initial practical implementation in the four early adopter Trusts can be built in to our development ahead of scale up to 25 sites in 2022
- continue the development of additional app functionality into broader areas of maternity care, such as postnatal mental and physical health, diabetes, hypertension, multiple pregnancy and miscarriage.
Due to the scale of the project, the app will firstly focus on identifying women at risk of premature birth and placental problems, which can show as pre-eclampsia or prevent baby growing properly, and lead to stillbirth. The capability to assess a woman’s risk of developing other complications linked to stillbirth will be built into the app as it develops.
The vision for all Tommy’s Centres is a future where the UK is the safest place in the world to give birth and excellent maternity care is available for all. Each Centre focuses on specific areas of research into pregnancy complications to prevent miscarriage, stillbirth and premature birth, and to save babies’ lives.
Each Centre conducts scientific research, clinical trials and runs clinics where women at risk of developing complications are supported before, and during pregnancy. Through this work, the Tommy’s Centres are involved in the production of clinical guidelines to improve and standardise maternity care in the UK, for example the Saving Babies’ Lives Care Bundle Version 2 (PDF).
The Tommy’s National Centre for Maternity Improvement is different to the other Centres funded by the Tommy’s charity because it focuses on translational research (taking research findings and putting them into practice), and closing the gap between best clinical science and the best maternity care.
The alliance between Tommy’s, the RCOG and the RCM means that this Centre has the support of the entire UK maternity workforce to help drive it forward. We are a Centre built on collaboration and made stronger through the input from our dedicated Tommy’s Centre Women’s Involvement Group, as well as our collaborative academic and charitable partners: the Universities of Bristol and Sheffield, St George’s University Hospitals, London, King’s College London, and the Mothers for Mothers and PROMPT Maternity Foundation charities.
Together we can meet our ambitious aims.