title: Early detection of severe maternal morbidity: a retrospective assessment of the role of an Early Warning Score System.
abstract: BACKGROUND
  The Early Warning Scoring (EWS) surveillance system is used to identify deteriorating patients and enable appropriate staff to be called promptly. However, there is a lack of evidence that EWS surveillance systems lead to a reduction in severe morbidity.
  
  
  OBJECTIVE
  To determine whether as EWS may have improved the detection of severe maternal morbidity or lessened the severity of illness among women with severe morbidity at a large tertiary maternity unit at Auckland City Hospital (ACH), New Zealand.
  
  
  METHODS
  Admissions to intensive care, cardiothoracic and vascular intensive care, or an obstetric high-dependency unit (HDU) were identified from clinical and hospital administrative databases. Case reviews and transcribed observation charts were presented to a multidisciplinary review group who, through group consensus, determined whether an EWS might have hastened recognition and/or escalation and effective treatment.
  
  
  RESULTS
  The multidisciplinary review team determined that an EWS might have reduced the seriousness of maternal morbidity in five cases (7.6%), including three admissions for obstetric sepsis to intensive care unit and two to obstetric HDU for post-partum haemorrhage. No patient had a complete set of respiratory rate, heart rate, blood pressure and temperature recordings at every time period.
  
  
  CONCLUSIONS
  These findings have been used to support introduction of an EWS to the maternity unit at ACH.
authors.affiliation: Auckland District Health Board, Auckland, New Zealand.
authors.forename: Diana M
authors.initials: DM
authors.lastname: Austin
authors.forename: Lynn
authors.initials: L
authors.lastname: Sadler
authors.forename: Claire
authors.initials: C
authors.lastname: McLintock
authors.forename: Colin
authors.initials: C
authors.lastname: McArthur
authors.forename: Vicki
authors.initials: V
authors.lastname: Masson
authors.forename: Cindy
authors.initials: C
authors.lastname: Farquhar
authors.forename: Sharon
authors.initials: S
authors.lastname: Rhodes
mesh_terms: D042241:Early Diagnosis; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic; D009520:New Zealand; D009775:Obstetrics and Gynecology Department, Hospital; D011247:Pregnancy; D011248:Pregnancy Complications / Q000145:classification / Q000175:diagnosis*; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: early warning score; maternal morbidity; surveillance systems