By Dr Manu Vatish, Consultant Obstetrician, Oxford University Hospitals, and Senior Clinical Fellow with the University of Oxford’s Nuffield Department of Women’s and Reproductive Health.
Pregnant women should be able to rely on the NHS for the best available care for them and their babies. But that doesn’t always happen.
I set out to achieve wider use of a proven test to avoid unnecessary ‘just in case’ hospital admissions for suspected pre-eclampsia. Its increased accuracy reliably rules out pre-eclampsia leading to more than 1,000 fewer admissions each year in the Thames Valley region alone. Across the country that means thousands of pregnant women avoid the unnecessary anxiety associated with going into hospital. At the same time maternity services are able to focus more on those women who are at greater risk of developing pre-eclampsia.
Pre-eclampsia is a serious disease that occurs in three per cent of all pregnancies. It is characterised by high blood pressure and protein in the urine. It leads to oedema and can result in organ failure and seizures in the mother. It can lead to restricted growth in the baby and often premature delivery, as delivery is the only “cure” for the disease. The additional cost to the NHS for treating pre-eclampsia is estimated at £9,000 per pregnancy.
Today, pre-eclampsia is diagnosed only by excluding all the other possible causes of high blood pressure and protein in the urine through a series of tests. These take time and cause anxiety for the mother-to-be and her family. Women with suspected pre-eclampsia are often admitted to hospital for observation “just in case”, sometimes for several days.
The new test is changing that approach by providing more information to help with the diagnosis. It was first trialled at Oxford University Hospitals where it has now been introduced as a standard test. The Oxford Academic Health Science Network is now overseeing its introduction into other hospitals in the Thames Valley region and beyond, through the AHSN Network. The test has also been identified for rapid uptake nationally by the Accelerated Access Collaborative which identifies highly transformative innovations and introduces an accelerated pathway to market.
The key has been combining industry innovation and research evidence to meet a known NHS need. That is where the AHSNs came in. The Oxford AHSN’s expertise and connections opened doors and enabled use of this test to spread from an initial hospital to multiple sites. They developed insight into pathways and needs as well as providing project management and business support for adoption.
The Oxford AHSN has forged strong partnerships with Roche Diagnostics who developed the test, and the clinical, laboratory and finance teams in each hospital to deliver tailored solutions.
This is a powerful example of better diagnostics leading to improvements in clinical care and system efficiencies. This was recognised when it won the ‘Best Healthcare Provider Partnership’ category of the HSJ Partnership Awards 2019.
- Editorial note: There are two tests for early diagnosis of pre-eclampsia in pregnant women designated as Accelerated Access Collaborative Rapid Uptake Products: the Elecsys immunoassay sFlt-1/PlGF (Roche Diagnostics) and Triage PlGF test (Quidel Corporation)