title: Implementation of a modified obstetric early warning system to improve the quality of obstetric care in Zimbabwe.
abstract: OBJECTIVE
  To implement a modified obstetric early warning system (MOEWS) to promote identification and stabilization of unwell women.
  
  
  METHODS
  A before-and-after study of MOEWS implementation took place between April 2013 and January 2014 in a government referral hospital in Bulawayo, Zimbabwe. After piloting MOEWS, cesarean case files were retrospectively assessed to compare preoperative stabilization. A longitudinal "spot-check" study measured use of MOEWS and action taken on abnormal results. A quality indicator was introduced to assess ongoing implementation.
  
  
  RESULTS
  Analysis of women undergoing cesarean before (n=79) and after (n=85) MOEWS implementation showed that preoperative stabilization improved significantly post-intervention (odds ratio 2.78, 95% confidence interval 1.39-5.54). The longitudinal analysis of women at baseline (n=43) and after (n=85) MOEWS implementation also showed a significant improvement in action taken (1/24 [4%] vs 28/45 [62%]; P=0.001). The 6-month aggregated quality indicator revealed that 78 (62%) of 125 patients had a completed MOEWS chart, with appropriate stabilization of 65 (93%) of 70 women.
  
  
  CONCLUSIONS
  Implementation of MOEWS improved women's care through action being taken on abnormal observations. Before whole-scale adoption of MOEWS in low-resource settings, the study should be scaled up and repeated to ensure replicable findings.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.|Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
authors.forename: Abi
authors.initials: A
authors.lastname: Merriel
authors.affiliation: Mpilo Central Hospital, Bulawayo, Zimbabwe.
authors.forename: Bobb T
authors.initials: BT
authors.lastname: Murove
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Samuel W D
authors.initials: SW
authors.lastname: Merriel
authors.affiliation: Bay of Plenty District Health Board, Whakatane Hospital, Whakatane, New Zealand.
authors.forename: Thabani
authors.initials: T
authors.lastname: Sibanda
authors.affiliation: Mpilo Central Hospital, Bulawayo, Zimbabwe.
authors.forename: Sikangezile
authors.initials: S
authors.lastname: Moyo
authors.affiliation: North Bristol NHS Trust, Bristol, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Crofts
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D020000:Decision Support Systems, Clinical / Q000592:standards*; D005260:Female; D006771:Hospitals, Maternity; D006801:Humans; D016015:Logistic Models; D000068097:Maternal Health / Q000592:standards*; D011247:Pregnancy; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D015030:Zimbabwe
keywords: Decision support tool; Early warning score; Low-resource setting; Maternal health; Recognition of deteriorating patients