EEPD Volume 5. Logical Priority Qs & As
A. FOUR PLACES SYSTEMS
Until now the EEPD has focused on a single “Logical Priority” set of Questions and all Allowable Answer Options based on the knowledge that, in the United Kingdom, every maternity hospital has, for the past 10-15 years, been able to guarantee a computer terminal in the following four clinical places - and nowhere else
a) whenever departmental Scans are done,
b) in the Delivery Suite
c) in all Maternity Wards (and Obstetric Theatres)
d) in all Neonatal Care Units.
which require different priority sets
of standardised electronic Questions & Answers
Until recently in the EEPD Volume 5 Priority has been given to “FOUR GUARANTEED PLACES” systems.
But an increasing number of hospitals have other patterns of “Guaranteed” IT access. In future consideration will need to be given to the consequences of the following alternatives patterns of IT access
B. FIVE PLACES GUARANTEED
This heading refers to any maternity care organisation where at, or shortly after, the Initial Assessment, there is a reliable opportunity to enter electronic data regarding the Initial Assessment Data documented in the hand-held record, when the data entered is subsequently used in a significant way.
This category excludes systems where the data is not used in any significant way before the mother is admitted in labour i.e. when the only purpose of entering such data is to reduce the data-entry workload when the mother is admitted.
An increasing number of U.K. hospitals insist that midwives spent a significant proportion of their working day entering a large quantity of Initial Assessment data from the hand-held paper record directly into a maternity computer system. Although there is no evidence that such systems improve the quality of maternity care, (in the editor’s personal experience in several hospitals, such systems decrease the quality of care) it does mean that more primary electronic data is available for management, audit and planning. If such data is being entered it will only be valuable for use nationally if the flow-pattern and wording can be nationally standardised. The existence of the EEPD provides an opportunity to encourage national standardisation of initial assessment primary data.
Many others districts such as Coventry insist that midwives, after completing the hand held record, also complete a proformas which is then sent to the hospital for secretaries to enter Initial Assessment data into the hospital maternity computer system within the next few weeks.
An alternative is for the hand-held record to be temporarily kept by the hospital and only given to the expectant mother after the secretaries have enter the Initial Assessment data.
“Four or Five Places Guaranteed” systems may have additional terminals and printers e.g. in management or administrative offices and even some terminals in ante-natal clinics but these are not necessary for a cost effective “Four Guaranteed Places System”
C. ONLY ONE PLACE GUARANTEED
Many hospitals in the two-thirds world now have at least a single stand alone terminal in the Maternity Suite. Under such circumstances it is even more important to recognise that, not only “Every Extra Keystroke Costs” but that in a busy, over-stretched unit in the two-thirds world with scores of births every day and with midwives only just surviving the pressure of chronic understaffing then “Every Single Keystroke Costs”
Entering data into a computer is then an extra task on top of the daily grind. But if we are to pursue “Safer Motherhood” we need accurate data for Audit and Management. It is therefore even more important to move towards electronic data entry systems which, based on an open internet debated, standardised flow-patterned, workload-conscious set of ONE PLACE Questions and all Allowable Answer Options of the highest possible quality.
D. EVERY PLACE SYSTEMS
A few organisations are attempting to go paperless. Such systems may work as independent entities; but as soon an there is a need for interoperability with any other electronic system there will still, in time, be a need for Q and A standardisation. For the present all such system known to the EEPD do not interface significantly with any other system