critically evaluate the role of day care unit in obstetric practise
Posted by Nibedita R.
The main aim for the establishment of obstetric day care is to allow more women to be cared for on an outpatient basis. The major advantage is that it reduces the need for inpatient investigation, observation and inpatient stay, it helps a considerable cost saving. In addition, stress of separation of the mother from the family unit can be minimised.
The wide range of women that would have been admitted to the antenatal wards may be alternatively cared for in this system. Referrals which would normally have come through the labour ward may be seen on the unit. An example would be a woman with decreased fetal movements. This allow the delivery suit to concentrate on obstetric emergencies and women in labour.
Obstetric day care is of particular value in the management with high risk pregnancies to be seen outside the normal busy clinic and have a team approach to their care. This is useful for both ensuring continuity of care and for research and medical audit.
However, in order for this system to work efficiently, the unit must be adequately staffed. A high midwife-to-patient ratio is required as the care and investigationsmust, of necessity, be provided in a shorter time span.
Direct access to medical staff is essential and time must be allocated within the medical staff timetable to ensure that the patients within the unit can be reviewed promptly when required. Otherwise the women can end up spending prolonged periods awaiting medical review.
Prompt access to Ultrasound, laboratory services and cardiotocography is essential.
unless strict protocols and referral criteria are maintained the efficacy and cost-effectiveness of the unit will be affected adversely.
the unit should not be used as a replacement for women who can be adequately managed in antenatal clinic or with home visits by the community midwives.
Posted by Vaijayanti R.
Day assessment units (DAUs) are an essential part of obstetric services today, though they do have some drawbacks.
Day Assessment Units provide antenatal care to those pregnant women who would require further monitoring/ multidisciplinary care/investigations on an outpatient basis. Some of the common conditions that are monitored at the DAUs are ? pregnancies complicated by growth restriction, hypertension, diabetes, reduced fetal movements etc.
The staff (Midwife, Maternity assistant, Obstetrician) of the DAU must be easily accessible not only to the patients, but to the health care providers ? GPs and midwives.
Facilities for USG, CTG and rapid dependable laboratory investigations must be available.Each DAU should have its own written protocols for management of various conditions ? this will not only ensure uniformity of care delivery, but also provide auditable standards.
By allowing patients to be cared for on an outpatient basis, thus reducing the need for hospitalization. This will not only reduce the costs incurred, but will also reduce the stress of the woman being separated fom her family for any length of time. Reducing the work load on the Delivery Suite personell, will allow them to focus on care of women in labour and Obstetric emergencies. Apart from this, multidisciplinary care can be organized for high risk pregnancies.
While the advantages are significant, this system has its drawbacks too.
The ease of repeated monitoring and access to patients may delay decision making , leading to sub optimal care.Some patients may not be comfortable with outpatient monitoring, and may request hospitalization. The frequent visits to a DAU may not be logistically convinienent to women who live far away for the Unit.While the DAUs reduce the work load on the Delivery Suite, they do increase the workload on the Gps and community midwives, as more patients are managed on an outpatient basis.More importantly, there is no evidence to suggest improved maternal/ perinatal outcome following care at the DAU.
The DAU should not be used for women who can be adequately managed at the regular antenatal clinic or by home visits by the community midwives
For these units to be cost effective and for ensuring optimal service delivery, the Units should have strict criteria on who should be cared for at these centres.
