title: Value of a modified early obstetric warning system (MEOWS) in managing maternal complications in the peripartum period: an ethnographic study.
abstract: OBJECTIVE
  To explore implementation of the modified early obstetric warning system (MEOWS) in practice to further understanding about the influence of contextual factors.
  
  
  METHODS
  An ethnographic study using observations (>120 h), semi-structured interviews (n=45) and documentary review was performed in the maternity services in two UK hospitals over a 7-month period. Doctors, midwives and managers participated in the study and data were analysed thematically.
  
  
  RESULTS
  For women admitted to hospital in the antenatal and postnatal period with an established risk of morbidity, the MEOWS enabled communication about vital signs from junior to senior midwives and obstetricians. The trigger prompts helped shape shared understandings of maternal complications. However, midwifery and obstetric staff questioned the added value of an extra chart in the postnatal period given the low incidence of maternal complications and the resulting increase in workload. In an effort to prioritise workload demands and respond to the immediate needs of both women and their babies, midwives exercised professional discretion regarding its use. However, discretionary use of MEOWS meant the loss of a potential universal safety net for detection of deterioration.
  
  
  CONCLUSIONS
  Despite a decade of use in acute settings, research into the effectiveness of early warning systems still yields conflicting results. Widespread policy support for the MEOWS is based on its intuitive appeal and no validated system for use in the maternity population currently exists. Our findings suggest that, while the MEOWS has value in structuring the surveillance of hospitalised women with an established risk of morbidity, the complexities of managing risk and safety within the maternity pathway, the associated opportunity costs of MEOWS and variation in implementation currently call into question its role for routine use.
authors.affiliation: King's College London, Women's Health Academic Centre, London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mackintosh
authors.forename: Kylie
authors.initials: K
authors.lastname: Watson
authors.forename: Susanna
authors.initials: S
authors.lastname: Rance
authors.forename: Jane
authors.initials: J
authors.lastname: Sandall
mesh_terms: D000328:Adult; D056902:Clinical Alarms / Q000592:standards* / Q000706:statistics & numerical data; D004059:Diffusion of Innovation; D005260:Female; D006771:Hospitals, Maternity; D006801:Humans; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000517:prevention & control; D010343:Patient Admission; D058725:Peripartum Period; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011296:Prenatal Diagnosis; D036301:Qualitative Research; D018570:Risk Assessment / Q000592:standards*; D055986:Vital Signs; D016526:Workload
keywords: Decision support, clinical; Qualitative research; Social sciences; Transitions in care; Womens health