Implementation of Joint Antenatal Care Appointments (Green Maternity Challenge)

Project completed as part of the National Green Maternity Challenge 2024-25 by the Whittington Health NHS Trust.

Implementation of Joint Antenatal Care Appointments: 

Team members:

• Meg Wilson - Consultant Gynaecologist and Obstetrician
• Ilana Pizer-mason - Consultant Midwife
• Gillian Delamotte - Matron for Maternity Outpatients
• Caitlin Daly, Assistant Service manager for Women’s Health

Setting / patent group: Maternity Services

Issue: 

Women attend many appointments during pregnancy, which are either led by midwives in community settings or by consultants in tertiary hospitals. This can lead to further travelling and longer waiting times for many women, causing women to take more time off work or arrange for childcare to attend these appointments. Some women, especially those from lower socioeconomic backgrounds, can face challenges such as logistical constraints, financial costs, and work or childcare commitments. Ultimately, this can increase health inequalities, missed appointments, undetected complications, and poorer birth outcomes.

A midwifery and consultant appointment taking place within a few days of each other can lead to tests being conducted unnecessarily as urine samples and observations are taken at all appointments. This can lead to an increase in healthcare’s carbon footprint and coordination challenges between healthcare providers.

Intervention: 

Transforming traditional antenatal healthcare delivery by streamlining the appointment process, to reduce the frequency of visits, can improve maternal satisfaction and perinatal outcomes while also reducing interventions. This is aimed to be achieved by strengthening multidisciplinary team collaboration, communication, and coordination. One of the interventions included joint appointments by midwives and with consultants over video call, reducing women’s travel to the hospital for traditional appointments. Women would attend their usual midwives consultation in person as usual and a consultant obstetrician would later join in via a video call. This involved increasing the consultation time from 25 minutes to 35 minutes, for appropriate assessment, discussion and documentation. It will also save 15 minutes of consultants and women’s time per appointment.

The project also targets a reduction in overall environmental impact of antenatal care delivery, for instance by minimising the consumption of disposable medical equipment.

Outcomes: 

Environmental

The impact of project, in terms of carbon footprint, can be estimated by calculating the emissions due to women’s travel, consumables and water use to collect samples for various tests (such as Urine tests) and energy use in the reception area. A reduction in emissions of up to 1.58 kgCO2e/woman is expected to be made through this project.

By reducing 3 face to face appointments per week through such joint appointments, GHG emissions could be reduced by 230.36 kgCO2e every year. Such appointments would also reduce medical waste generation.

Social

Surveys conducted among patients have showed that many women had to attend multiple appointments in the same week and there was a unanimous support among the surveyed patients for joint appointments.

With an average travel time of 30mins for each hospital visit, it is expected that they will save atleast around 45 minutes for each appointment. This will also save time associated waiting periods and clinical delays, and hence, save more time in reality.

Increased multidisciplinary team coordination will also lead to improved job satisfaction and lead to a sense of professional fulfilment. It will also save time for the consultant and the midwives, enabling them to focus on high value work that aligns with their expertise.

Clinical

This project will enhance patient centred care by conducting joint appointments, saving patients’ time, and reducing the likelihood of patients not attending the appointments, while also making sure that national guidelines are being met. Hence, no change on women’s pregnancy and health outcomes is expected, while increasing access to equitable healthcare to the patient group.

Joint appointments also foster a stronger coordination between multidisciplinary teams and more robust team working, resulting in better patient care.

Financial

Conducting tests twice can be avoided and this can lead to financial savings of £8.69 for every urine test and 26p for every carbon monoxide test tube.

Based on a reduction of 156 appointments in a year, £1,355 are expected to be saved from reducing unnecessary urine tests and £40.56 from a reduction in carbon monoxide test tube use, leading to total yearly savings of £1395.56

Key learning point:

The pilot project shows convincing evidence that streamlining antenatal care through joint appointments is sustainable and effective healthcare delivery model, which can lead to reductions in emissions as well as medical waste generation. Moreover, it also enhances the quality of care delivered through improved collaboration and accessibility.

The nature of the project makes it suitable for wider implementation across different healthcare settings. Both rural and urban maternity units can benefit from this approach, with suitable changes made to the project as per local requirements. Some of the possible barriers are facilitating room availability to facilitate longer appointments and coordinating consultant and midwives job plans for the joint appointments.