Impact of pregnancy after loss “Rainbow Clinic” in a UK university hospital, on continuity, unplanned attendances and cost; a mixed methods study

Impact of pregnancy after loss “Rainbow Clinic” in a UK university hospital, on continuity, unplanned attendances and cost; a mixed methods study

Authors: Tomlinson BGC, Kordtomeikel KL, Gibson AB

Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom.

Background:
Norfolk and Norwich University Hospital in the East of England, United Kingdom has approximately 6000 babies delivered per annum and provides obstetric care via a number of themed clinics. A specialised Rainbow clinic was introduced to provide care for women and their families with pregnancy after loss. The Rainbow team consists of a Consultant Obstetrician and Specialist Bereavement Midwife who provide holistic care in a continuity model. This is a mixed methods study, qualitatively examining the early impact of Rainbow Clinic on continuity of obstetric carer, numbers of both planned and unplanned admissions along with cost saving modelling.

Methods:
Unmatched cohort data was analysed from hospital notes, handheld notes and the maternity IT system (Euroking). All women who have been referred to Rainbow Clinic and subsequently delivered were included in the Rainbow Cohort, the same number of women immediately preceding introduction of the Rainbow Clinic made up the Pre-Rainbow Cohort. A review of published data was performed to provide estimates for the cost saving modelling.

Results:
There was a reduction in planned attendances in the Rainbow cohort 6.83 appointments versus 8.33 in pre-Rainbow cohort. There was a statistically significant reduction in the number unplanned attendances in the Rainbow cohort (2.33 attendances versus 8.16 in pre-Rainbow cohort). The authors also noted a reduction in number of different clinicians seen at planned appointments in post-Rainbow cohort (3.66 versus 5.6 in pre-Rainbow cohort) and an increase in number of times seen by the same clinician (4.16 versus 3.33 in pre-Rainbow cohort).

Conclusion:
This cohort study demonstrates an association between continuity of carer in pregnancy after loss care and a reduction in unplanned attendances in the antenatal period.
The authors have also demonstrated the potential financial savings associated with this model of care.

Ethics statement:
Ethics approval was not sought.

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