Maternal Critical Care Survey (MaCriCare) new new

European survey of current practices

and service availability in maternal critical care.

Dear participant,

Thank you for your interest in MaCriCare, an international project focused on improving the provision of maternal critical care. The first stage of our work aims to establish a baseline of current practices and service availability by surveying units throughout Europe and beyond. Your National coordinator has identified you as a lead in a center with labor and delivery services.

The survey takes about 10-15 minutes to complete. Please answer the questions relating to your unit’s activity to the best of your knowledge and ability. If there are any areas of uncertainty, or where you wish to add further information, please add your comments in the free-text box at the end.

In order to permit ongoing communication it is important for us to store the contact details of all contributors: we are grateful for you consenting to this on next page.

Thank you once again for your participation and contribution.

Warm regards

The MaCriCare Project Team

Steve Cantellow (UK), Dominika Dabrowska (UK), Emilia Guasch (Spain), Henrik Jörnvall (Sweden), Paweł Krawczyk (PL),
Nuala Lucas (UK), Frédéric J. Mercier (France), Alexandra Schyns-van den Berg (NL), Carolyn Weiniger (Israel).

There are 40 questions in this survey.

Respondent data

I hereby give consent for my personal data to be processed in matters pertaining to: e-mail address for the purposes of communication and creating the study contributors list in accordance with the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 with regard to the processing of personal data and in accordance with the information clause attached to my consent. *

Please choose only one of the following:

In accordance with Article 13 of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data (…) (“General Regulations”) the Jagiellonian University informs that, the administrator of your personal data is the Jagiellonian University 24 Gołębia Street, 31-007 Krakow. A Data Protection Officer has been appointed by the Jagiellonian University who is based at 24 Gołębia Street, 31-007 Krakow. The Officer can be contacted via e-mail: iod@uj.edu.pl or by phone – +48 12 663 12 25. Your personal data will be processed for the purpose of communication and creating the study contributors list on the basis of Maternal Critical Care project. Providing personal data is voluntary. However, it is obligatory for the purpose of communication and creating the study contributors list. Your personal data will be stored until the consent is withdrawn, but not longer than for a period of 5 years. You have the right to: access the data and demand its rectification, deletion, processing restrictions, transfer the data, object to the processing of data, withdraw your consent at any time in cases and under the conditions stipulated in “General Regulations”. The withdrawal of consent shall result in delating the data from database. The withdrawal of consent may be sent by email to p.krawczyk@uj.edu.pl or In person at Department of Anesthesia and Intensive Care Medicine Jagiellonian University Medical College, Kopernika 17 street, 31-501 Cracow Poland. You have the right to file a complaint with The President, Personal Data Protection Office (UODO) if you consider the processing of your personal data to be in violation of the provisions of the “General Regulations”.

I hereby confirm that I have read and understood the above information.
*

Please choose only one of the following:

Data of the survey participant *

Specific questions for each obstetric unit

City or town *

Please write your answer here:

Hospital/Unit name *

Please write your answer here:

Please describe highest level of care your unit provides:

*

Please choose only one of the following:

Primary (including Midwife-led units)
Secondary Obstetric Care
Tertiary Obstetric Care
Other

Maternity unit beds. *

Does your unit use MEOWS (modified early obstetric warning score) or other? *

Please choose only one of the following:

Yes
No
Other

Is the unit within a university hospital? *

Please choose only one of the following:

Yes
No
Other

Is the unit within a teaching hospital? *

Please choose only one of the following:

Yes
No
Other

Does the unit provide postgraduate teaching in: *

Please choose the appropriate response for each item:

	Yes	No	Other
Obstetrics
Anaesthesia
Midwifery

Service availability (please tick the box if available in your unit)

Mark DOT if service available (just ONE the closest location available for the obstetric patient)*

It is understood that in some units it may be possible to initiate these therapies but the patient would need to be transferred elsewhere in order for the therapy to be continued. For the purposes of this survey, this means that the service is not routine and DOT should not be selected

^In respect of recovery areas after surgery/ anaesthesia, unless the therapy specified can be*

sustained for >24 hours in these areas, the DOT should not be selected
*

Please choose the appropriate response for each item:

	Same ward/ adjoining	Same building	Different building	Different hospital	Not available
Dedicated operating room(s) (‘theatres’) for obstetric patients
Cell saver
Transfusion services (‘blood bank’)
Neonatal Intensive Care
Ultrasound imaging equipment
Invasive blood pressure monitoring
Hypotensive agent infusions
Vasopressor infusions
Intra-aortic balloon pump
Cardiac output monitoring
Non-invasive ventilation
Invasive ventilation
ECMO
Renal replacement therapy
24/7/365 Interventional Radiology Service is available
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT)
Specialist Trauma Service
Specialist Burns Service
Specialist Neurosurgical Service
Specialist Acute Stroke Service
Specialist Cardiothoracic Service
Specialist Psychiatric Service
Ability to accommodate COVID-19 suspected or confirmed patients
Laboratory services (including ability to assess full blood count, biochemistry and coagulation)
Thromboelastometry (TEG/ROTEM)
POC Blood gas analysis (POC = point of care)
POC for Haemoglobin (eg Hemocue) (POC = point of care)
POC lactate (POC = point of care)
POC glucose (POC = point of care)
POC INR (POC = point of care)

Critical Care Capacity^

Definition: number of beds providing formal HDU (High Dependency Unit) and ICU (Intensive Care Unit), staffed 24/7 by nurses or midwives with full critical care training.
HDU: ability to provide routine invasive monitoring, vasopressor therapy and non-invasive ventilation.
ICU: ability to provide routine invasive ventilation
^With regard to post-anaesthesia care areas (‘recovery areas’): unless the above therapies can be sustained for >24 hours, these beds should not be included here.
*

Staffing and facilities within maternity unit

Are patients requiring invasive monitoring routinely cared for in the maternity unit? *

Please choose only one of the following:

Yes
No
Other

Maternity Unit Leadership *

Please choose the appropriate response for each item:

	Yes	No	Other
Named senior doctor with a specific interest in maternal critical care service provision and oversight
Named senior midwife with responsibility for maternal critical care service provision and oversight

Critical Care Outreach *

Please choose the appropriate response for each item:

	Yes	No	Other
Outreach service that covers maternity unit 24/7/365
Outreach service that covers maternity unit <24/7/365
The majority of outreach service staff have undertaken additional specific training in maternity competencies

Maternity Unit Staffing *

Please choose the appropriate response for each item:

	Yes	No	Other
Routine availability of dual trained staff (full accreditation in midwifery and full accreditation critical care)
Routine availability of midwives with partial critical care competencies/accreditation
Routine continuous presence of a critical care nurse during the critical illness episode
24/7/ 365 availability of a senior anaesthetist with a specific interest in Obstetric Anaesthesiology

Please provide information on midwife to patient ratio for labouring women (e.g. 1:1 means one midwife to one patient)
*

Critical care review on the Maternity Unit *

Please choose the appropriate response for each item:

	Yes	No	Other
Critical Care Physician reviews critically unwell maternity patients on the maternity unit daily, or more frequently

Guidelines and policies on the Maternity Unit *

Please choose the appropriate response for each item:

	Yes	No	Other
Availability of local maternity specific critical care guidelines and policies

Support and follow-up for Maternity Unit patients *

Please choose the appropriate response for each item:

	Yes	No	Other
Critically unwell maternity patients are routinely followed up after discharge home in a dedicated critical care post-discharge clinic
Critically unwell maternity patients are routinely screened for psychological trauma either before or after discharge home
Debriefing/ psychological support for staff is available in the event of poor maternal outcome

Maternity Unit data collection *

Please choose the appropriate response for each item:

	Yes	No	Other
Unit collects data on critically unwell maternity patients for the purposes of local quality control
Unit submits data on critically unwell maternity patients to national database (e.g. ICNARC/ ProSAFE)

Staffing and facilities within critical care

Can critically ill obstetric patients be cared for outside of the maternity unit within the same hospital? *

Please choose only one of the following:

Yes
No
Other

Critical Care Leadership *

Please choose the appropriate response for each item:

	Yes	No	Other
Named senior doctor with a specific interest in maternal critical care service provision and oversight
Named senior nurse with responsibility for maternal critical care service provision and oversight

Critical Care Unit staffing *

Please choose the appropriate response for each item:

	Yes	No	Other
Routine availability of dual trained staff (full accreditation in midwifery and full accreditation in critical care)
Routine availability of nursing staff with additional maternity competencies
Routine continuous presence of a midwife while in critical care
Routine availability of midwife to attend unit (but not continuously present)

Please provide information on nurse to patient ratio for intubated patients (e.g. 1:1 means one nurse to one patient)
*

Obstetric review *

Please choose the appropriate response for each item:

	Yes	No	Other
Obstetric review of maternity patients on this unit occurs daily, or more frequently

Guidelines and policies *

Please choose the appropriate response for each item:

	Yes	No	Other
Availability of local maternity specific critical care guidelines and policies

Emergency services/ equipment *

Please choose the appropriate response for each item:

	Yes	No	Other
Continuous CTG (cardiotocography) monitoring and interpretation
Immediate availability of uterotonic drugs
Immediate availability of equipment for perimortem caesarean section
Immediate availability of neonatal resuscitation equipment
Resuscitation team (dedicated team who can respond to emergencies) able to attend unit 24/7/365
Neonatal resuscitation team able to attend unit 24/7/365

Support and follow-up for Critical Care Unit patients and staff *

Please choose the appropriate response for each item:

	Yes	No	Other
Breast feeding support/ initiation
Physical contact between mother and baby is routinely facilitated while mother is in ICU
Virtual contact between mother and baby is routinely facilitated while mother is in ICU (e.g. using video-calls)
Maternity patients are routinely given separate accommodation (‘side rooms’)
Maternity patients are routinely followed up after discharge home in a critical care clinic or equivalent
Maternity patients are routinely screened for psychological trauma either before or after discharge home
Debriefing/ psychological support for staff is available in the event of poor maternal outcome

Critical Care Unit data collection *

Please choose the appropriate response for each item:

	Yes	No	Other
Unit collects data on maternity patients for the purposes of local quality control
Unit submits data on maternity patients to national database (e.g. ICNARC/ ProSAFE)

4 scenarios

Please give general approach in your unit rather than your individual practice.

It will help us understand your unit better if you could indicate how the following scenarios are routinely managed.

Case 1 Pre-eclampsia
Severe pre-eclampsia requiring intravenous infusion of hypotensive agent and invasive monitoring. Select option which applies
*

Please choose only one of the following:

Managed within the maternity unit before delivery and after delivery
Managed within the maternity unit before delivery and in a separate critical care after delivery
Managed within a separate critical care before delivery and after delivery
The patient is transferred to another hospital
Other

Case 2 Postpartum hemorrhage
Major postpartum haemorrhage requiring an examination under general anaesthetic. After a blood loss of 3 litres, the bleeding has been controlled and physiological parameters are rapidly normalised. The patient is extubated. Uterine tone is normal.
*

Please choose only one of the following:

Managed within the maternity unit
Managed in a separate critical care unit
The patient is transferred to another hospital
Other

Case 3 Postpartum hemorrhage
Major obstetric haemorrhage requiring caesarean hysterectomy and massive transfusion. The bleeding is under control but there is an ongoing metabolic disturbance and the patient requires ongoing ventilation and vasoactive agent administration
*

Please choose only one of the following:

Managed within the maternity unit
Managed in a separate critical care unit
The patient is transferred to another hospital
Other

Case 4 Sepsis
A patient with chorioamnionitis is delivered by emergency caesarean section. Soon after delivery she develops a vasopressor requirement along with a worsening lactataemia
*

Please choose only one of the following:

Managed within the maternity unit
Managed in a separate critical care unit
The patient is transferred to another hospital
Other

Any additional comments

Please write your answer here:

THANK YOU!

Submit your survey.
Thank you for completing this survey.

Maternal Critical Care Survey (MaCriCare) new new

Respondent data

Data of the survey participant *

Specific questions for each obstetric unit

Country *

Voivodeship *

City or town *

Hospital/Unit name *

The unit capacity – number of deliveries per year: *

Please describe your unit: *

Please describe highest level of care your unit provides: *

Maternity unit beds. *

Does your unit use MEOWS (modified early obstetric warning score) or other? *

Is the unit within a university hospital? *

Is the unit within a teaching hospital? *

Does the unit provide postgraduate teaching in: *

Service availability (please tick the box if available in your unit)

Staffing and facilities within maternity unit

Are patients requiring invasive monitoring routinely cared for in the maternity unit? *

Maternity Unit Leadership *

Critical Care Outreach *

Maternity Unit Staffing *

Please provide information on midwife to patient ratio for labouring women (e.g. 1:1 means one midwife to one patient) *

Critical care review on the Maternity Unit *

Guidelines and policies on the Maternity Unit *

Support and follow-up for Maternity Unit patients *

Maternity Unit data collection *

Staffing and facilities within critical care

Can critically ill obstetric patients be cared for outside of the maternity unit within the same hospital? *

Critical Care Leadership *

Critical Care Unit staffing *

Please provide information on nurse to patient ratio for intubated patients (e.g. 1:1 means one nurse to one patient) *

Obstetric review *

Guidelines and policies *

Emergency services/ equipment *

Support and follow-up for Critical Care Unit patients and staff *

Critical Care Unit data collection *

4 scenarios

Case 1 Pre-eclampsia Severe pre-eclampsia requiring intravenous infusion of hypotensive agent and invasive monitoring. Select option which applies *

Case 2 Postpartum hemorrhage Major postpartum haemorrhage requiring an examination under general anaesthetic. After a blood loss of 3 litres, the bleeding has been controlled and physiological parameters are rapidly normalised. The patient is extubated. Uterine tone is normal. *

Case 3 Postpartum hemorrhage Major obstetric haemorrhage requiring caesarean hysterectomy and massive transfusion. The bleeding is under control but there is an ongoing metabolic disturbance and the patient requires ongoing ventilation and vasoactive agent administration *

Case 4 Sepsis A patient with chorioamnionitis is delivered by emergency caesarean section. Soon after delivery she develops a vasopressor requirement along with a worsening lactataemia *

Any additional comments

Please describe highest level of care your unit provides:

*

Please provide information on midwife to patient ratio for labouring women (e.g. 1:1 means one midwife to one patient)
*

Please provide information on nurse to patient ratio for intubated patients (e.g. 1:1 means one nurse to one patient)
*

Case 1 Pre-eclampsia
Severe pre-eclampsia requiring intravenous infusion of hypotensive agent and invasive monitoring. Select option which applies
*

Case 2 Postpartum hemorrhage
Major postpartum haemorrhage requiring an examination under general anaesthetic. After a blood loss of 3 litres, the bleeding has been controlled and physiological parameters are rapidly normalised. The patient is extubated. Uterine tone is normal.
*

Case 3 Postpartum hemorrhage
Major obstetric haemorrhage requiring caesarean hysterectomy and massive transfusion. The bleeding is under control but there is an ongoing metabolic disturbance and the patient requires ongoing ventilation and vasoactive agent administration
*

Case 4 Sepsis
A patient with chorioamnionitis is delivered by emergency caesarean section. Soon after delivery she develops a vasopressor requirement along with a worsening lactataemia
*