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P268 Pregnancy Loss in the Emergency Room: Why a Walled Room is Better Than a Curtained Cubicle
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Selected Abstracts
1
Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland 2 Cork University Maternity Hospital, Wilton, Cork, Ireland Objectives: Perinatal palliative care is the planning and provision of supportive care during life and end-of-life care for a baby and family in the management of life-limiting conditions. The complexity and diversity of antenatal presentations, involving degrees of uncertainty regarding prognosis, anticipated lifespan and severity of condition, requires a comprehensive and individualised approach to palliative care from diagnosis. In our maternity hospital, these pregnancies are cared for by a multidisciplinary team, including fetal medicine specialists, neonatologists, midwife sonographers, bereavement specialist midwives, social-work counsellors and chaplaincy. Methods: This was a retrospective review from 20122015 of all pregnancies with prenatally-diagnosed life-limiting fetal anomaly, which resulted in stillbirth or neonatal death. We excluded pregnancies diagnosed within 1-2 weeks of delivery, or those where the team had limited involvement. Cases were identified from birth registers and clinic records, with data supplemented by individual chart review. Data were analysed using Microsoft Excel. Results: There were 61 pregnancies with life-limiting fetal anomaly (including 7 multiple pregnancies) where parents chose to continue their pregnancy and were managed by the multidisciplinary team. Diagnosis was at a median gestation of 20.5 weeks (range; 12-28) and included anencephaly (8), major trisomy (14), renal agenesis (7), triploidy (4), thanatophoric dysplasia (2) and complex congenital heart disease (5). Thirty-one infants (31/61;51%) were stillborn and delivered at a median gestation of 32+2 weeks (range;23-40+2). The remaining infants delivered at a median gestation of 36 weeks (range; 28-39). Twenty died on the first day of life, 8 died between day 2 and 6 and two infants died at home on days 7 and 11 respectively. Conclusions: The multidisciplinary team approach is based on respect, dignity, compassion and support. With 15 pregnancies managed by the team each year, skilled expertise has developed in caring for families following antenatal diagnosis of life-limiting fetal anomalies.
P268 Pregnancy Loss in the Emergency Room: Why a Walled Room is Better Than a Curtained Cubicle
Lucia Hartigan1,2, Leanne Cussen1,2, Sarah Meaney1,3, Keelin O’Donoghue1,2
Vol. 52 No. 6 December 2016
1
Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland 2 Cork University Maternity Hospital, Wilton, Cork, Ireland 3 National Perintal Epidemiology Centre, University College Cork, Cork, Ireland During pregnancy, clinical situations of a sensitive nature occur and women may present with unexpected pregnancy loss or receive other bad news. The surrounding environment and lack of privacy in clinical areas can compound distress. In our hospital, the Emergency Room (ER) is a 24-hour facility, where >17,000 women are seen annually. Patient care in the ER was compromised by its physical design, as cubicles’ curtains and trolley spacing gave little privacy. Following recent renovations, we conducted a study to explore if refurbishments improved the ER patient experience. We prepared a survey asking specific questions about privacy and confidentiality. We repeated the survey following renovations, after which the size of the ER remained the same but individual walled cubicles with sliding doors replaced curtained spaces. Before renovations, 49% of pregnant women reported overhearing a conversation about themselves during their ER visit. After the walls were put up, this dropped to 11% (37/75 vs. 9/82;p LT 0.0001). Similarly, 49% overheard a conversation about another woman while in a cubicle pre-renovation, with this dropping to 10% afterwards (37/75 vs. 8/82;p LT 0.0001). Conversations were overheard at the nurses’ station, in the cubicle alongside, and extended to hearing staff talking about personal medical details. Women commented explicitly on what they saw or heard during their visit to the ER; this included seeing blood on the floor, and hearing fetal heart recordings. Only 21% women found their privacy to be adequate during their visit to the ER before the refurbishments, with this rising to 89% afterwards (16/75 vs. 73/82;p LT 0.0001). The physical space that surrounds the experience of pregnancy loss is hugely relevant. Refurbishment of our ER has significantly improved privacy and confidentiality for women attending. We recommend that other Obstetric units consider walled rooms instead of curtained cubicles when renovating or designing new ER departments.
P271 Palliative Care of Children with Malignant Pontine Tumours Fyeza Hasan, Kevin Weingarten, Adam Rapoport, Eric Bouffet, Ute Bartels, Sick Kids, Toronto, ON, Canada
Selected Abstracts
1
Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland 2 Cork University Maternity Hospital, Wilton, Cork, Ireland Objectives: Perinatal palliative care is the planning and provision of supportive care during life and end-of-life care for a baby and family in the management of life-limiting conditions. The complexity and diversity of antenatal presentations, involving degrees of uncertainty regarding prognosis, anticipated lifespan and severity of condition, requires a comprehensive and individualised approach to palliative care from diagnosis. In our maternity hospital, these pregnancies are cared for by a multidisciplinary team, including fetal medicine specialists, neonatologists, midwife sonographers, bereavement specialist midwives, social-work counsellors and chaplaincy. Methods: This was a retrospective review from 20122015 of all pregnancies with prenatally-diagnosed life-limiting fetal anomaly, which resulted in stillbirth or neonatal death. We excluded pregnancies diagnosed within 1-2 weeks of delivery, or those where the team had limited involvement. Cases were identified from birth registers and clinic records, with data supplemented by individual chart review. Data were analysed using Microsoft Excel. Results: There were 61 pregnancies with life-limiting fetal anomaly (including 7 multiple pregnancies) where parents chose to continue their pregnancy and were managed by the multidisciplinary team. Diagnosis was at a median gestation of 20.5 weeks (range; 12-28) and included anencephaly (8), major trisomy (14), renal agenesis (7), triploidy (4), thanatophoric dysplasia (2) and complex congenital heart disease (5). Thirty-one infants (31/61;51%) were stillborn and delivered at a median gestation of 32+2 weeks (range;23-40+2). The remaining infants delivered at a median gestation of 36 weeks (range; 28-39). Twenty died on the first day of life, 8 died between day 2 and 6 and two infants died at home on days 7 and 11 respectively. Conclusions: The multidisciplinary team approach is based on respect, dignity, compassion and support. With 15 pregnancies managed by the team each year, skilled expertise has developed in caring for families following antenatal diagnosis of life-limiting fetal anomalies.
P268 Pregnancy Loss in the Emergency Room: Why a Walled Room is Better Than a Curtained Cubicle
Lucia Hartigan1,2, Leanne Cussen1,2, Sarah Meaney1,3, Keelin O’Donoghue1,2
Vol. 52 No. 6 December 2016
1
Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland 2 Cork University Maternity Hospital, Wilton, Cork, Ireland 3 National Perintal Epidemiology Centre, University College Cork, Cork, Ireland During pregnancy, clinical situations of a sensitive nature occur and women may present with unexpected pregnancy loss or receive other bad news. The surrounding environment and lack of privacy in clinical areas can compound distress. In our hospital, the Emergency Room (ER) is a 24-hour facility, where >17,000 women are seen annually. Patient care in the ER was compromised by its physical design, as cubicles’ curtains and trolley spacing gave little privacy. Following recent renovations, we conducted a study to explore if refurbishments improved the ER patient experience. We prepared a survey asking specific questions about privacy and confidentiality. We repeated the survey following renovations, after which the size of the ER remained the same but individual walled cubicles with sliding doors replaced curtained spaces. Before renovations, 49% of pregnant women reported overhearing a conversation about themselves during their ER visit. After the walls were put up, this dropped to 11% (37/75 vs. 9/82;p LT 0.0001). Similarly, 49% overheard a conversation about another woman while in a cubicle pre-renovation, with this dropping to 10% afterwards (37/75 vs. 8/82;p LT 0.0001). Conversations were overheard at the nurses’ station, in the cubicle alongside, and extended to hearing staff talking about personal medical details. Women commented explicitly on what they saw or heard during their visit to the ER; this included seeing blood on the floor, and hearing fetal heart recordings. Only 21% women found their privacy to be adequate during their visit to the ER before the refurbishments, with this rising to 89% afterwards (16/75 vs. 73/82;p LT 0.0001). The physical space that surrounds the experience of pregnancy loss is hugely relevant. Refurbishment of our ER has significantly improved privacy and confidentiality for women attending. We recommend that other Obstetric units consider walled rooms instead of curtained cubicles when renovating or designing new ER departments.
P271 Palliative Care of Children with Malignant Pontine Tumours Fyeza Hasan, Kevin Weingarten, Adam Rapoport, Eric Bouffet, Ute Bartels, Sick Kids, Toronto, ON, Canada