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Clinical Practice Group: sharing early pregnancy pathway expertise

Posted: 16 December 2019

Picture of ultrasound
One-stop service; safer, quicker and better for pregnant women

- One-stop service: same day medical management offered to pregnant women and surgery offered within 48 hours

- Facility expanded to offer a six day a week service, including bank holidays

- More than 4,500 women scanned annually and over 90% percent diagnosed within 24 hours of presentation

Clinical Practice Groups (CPGs) are clinical oversight teams which lead the way in reducing unwarranted variation and improving care to patients across all hospitals.

WHHT is currently working with the Royal Free London hospitals on eight care pathways; the wheezy Child, pneumonia, induction of labour, anaemia, right upper quadrant pain, early pregnancy, prostate and frailty.

A best-practice early pregnancy pathway, introduced by WHHT’s Clinical Director for Gynaecology Alero Awala, has led the way in the rest of the group aiming to follow suit.

In 2017 hospital leads first met to share existing patient pathways and examine how they could streamline the care for all women with pain or bleeding in early pregnancy and ensure, if possible, a timely and accurate diagnosis of pregnancy.

They considered how and where patients were scanned, the referral process and how many steps were involved in that process.

This highlighted that WHHT were doing things in the most timely, efficient way possible and has meant a roll out of this model pathway to the fellow hospitals.

What are we doing right?

WHHT has clinical nurse specialists trained in early pregnancy and emergency gynaecology who are also fully trained sonographers. This means that the nurse sonographers scan, diagnose, discuss and only refer to doctor if necessary.

They offer a one-stop service where the vast majority of patients are seen within 24 hours of referral refer from a GP, A&E or a midwife.

Medical management can be offered on the day and surgery can be offered within 48 hours and the scan nurse can tell the woman the results and discharge on the spot. Alternatively, if there is an issue which must be dealt with, they can go next door to be seen by the on-call call team.

Also, women do not have to wait around once referred. They are given an appointment time so they can rest at home in comfort until they are seen.

Picture of Miss Alero AwalaThe service was set up ten and a half years ago by Miss Alero Awala, WHHT’s Lead for Acute Gynaecology and Clinical Director for Gynaecology. The service has now expanded over the years to offer a six day a week service including bank holidays.

They have four clinical nurse specialist/sonographers (two more to be trained next year), two consultants and a clinical fellow.

Miss Alero Awala said: “It’s a small unit but we’ve got it right. Because of quick access to good quality scans and quick resolution of problems if there are any, we can offer reassurance within 24 hours if there is a problem.

“We knew that we are delivering the gold standard in care for our patients and the Clinical pathway Group confirmed this. The other hospitals are now striving towards implementing a mirror system because they know it works. We have great pride in our team because we know we are offering the best service that you can to women who are vulnerable and in distress.”

There are plans afoot to work with patients to continue to monitor the patient experience and they are also planning to introduce self-referral for patients to go directly to the early pregnancy unit and bypass the GP, A&E and midwife.


Notes to editors

  1. For more information, please contact the communications team on: 01923 436280 or email: Out of hours, please call 07900 228031.
  2. West Hertfordshire Hospitals NHS Trust serves people from across Hertfordshire, north London and further afield. It operates from three hospitals; Watford General, St Albans City and Hemel Hempstead. The trust has a catchment area of over 500,000 people and is one of the largest employers locally, with around 5,000 staff and volunteers.
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