Dr Vinita Rane1, Miss Seda Kiroglu1,2, Dr Siaw Wong1,3
1Northern Health, Epping, Australia, 2University of Melbourne, Parkville, Australia, 3Mercy Hospital for Women, Heidelberg, Australia
Biography:
Biographies to come
Abstract:
Background: Pregnancy is a time of great anticipation, excitement and fear. Pregnancy is not an illness, but for some women, the symptoms of pregnancy can be very debilitating. For those suffering from common complications of pregnancy, such as hyperemesis gravidarum (HG) and preeclampsia, this can lead to frequent hospital readmissions. The Medical Obstetrics at Home (MOAH) initiative, an Australian first, provides comprehensive care at home, bridging the gap between hospital care and struggles at home. This study evaluates the impact of the introduction of this service on readmission rates for preeclampsia and HG at a large maternity service in the outer Northern suburbs of Melbourne, Australia.
Methods: Functioning as a Hospital-in-the-Home service, MOAH facilitates midwives in delivering essential pregnancy and post-pregnancy care at home, under the remote guidance of a Medical Obstetrics Consultant Physician. Typical patients enrolled in MOAH have either HG or a hypertensive disorder of pregnancy (including pre-eclampsia). Treatment involves a combination of home visits and telehealth consultations. Home visits enable the delivery of intravenous fluids and blood pressure monitoring. This audit explores the impact of the MOAH service since its inception. We utilized routinely collected admission data available via Decision Support and the Northern Health online reporting portal to examine whether the MOAH service has made a difference in unplanned hospital representations and readmissions for patients with a hypertensive disorder of pregnancy or hyperemesis gravidarum.
Results: Since 2022, MOAH has supported over 2134 patients, 32% of births at Northern Health. In contrast to the statewide increase in readmissions1 by 30%, preeclampsia readmissions dropped (0.35% to 0.22%) by 37%. HG readmissions dropped by 50%, from 9% to 4%.
Conclusion: MOAH is an innovative, patient-centred service that provides care comfortably and safely at home. It has reduced avoidable hospital admissions and is likely to be a scalable model.
Keywords
pre-eclampsia, home care, hyperemesis gravidarum, hospital in the home
References
1Lisa Hui MM, Mary-Ann Davey, Caroline Homer, Tanya Farrell, Miranda Davies-Tuck, Mark Umstad. COVID-19 COMMUNIQUE: A report on maternal and newborn outcomes during the COVID -19 pandemic.: https://www.safercare.vic.gov.au; 2023