“This test has improved our ability to make the right decision on admission. The right patients are being discharged, leaving us to focus on those women who are at greater risk of developing pre-eclampsia.”
Dr Sofia Cerdeira, obstetrician and research leader, Oxford University Hospitals
Overview

Quick, accurate blood tests which can help rule out pre-eclampsia are improving care for pregnant women and their unborn babies, reducing anxiety and saving the NHS money. AHSNs are leading a rapid adoption project for these tests into maternity units across the country.

Rapid uptake means these tests are becoming available to thousands more pregnant women – up from 29,000 in March 2019 to a predicted 200,000+ by the end of December 2019. The award-winning NHS/research/industry partnership has been selected for the NHS England Accelerated Access Collaborative, Innovation Technology Payment and Rapid Uptake programmes in 2019/20 which introduce an accelerated pathway to market for highly transformative innovations. Initially led by the Oxford AHSN, the initiative is now backed nationally by all AHSNs. Detailed implementation packs have been developed covering changes required to pathways and practices. These make it relatively straightforward to replicate at any maternity unit which is supported by a laboratory. A collaborative, multi-disciplinary approach is enabling improved decision-making and clinical risk reduction. This in turn is leading to improvements to patient safety, experience and satisfaction. Projected annual savings in England are estimated at £4m per year relating to reduced hospital bed occupancy. There is growing international interest in adopting this model.

Challenge / problem identified

Pre-eclampsia (PE) is a multi-system hypertensive disorder – a serious disease that occurs in around four per cent of all pregnancies (about 23,000 annual cases in the UK). It causes high blood pressure, protein in the urine and oedema and can result in maternal organ failure, restricted foetal growth and pre-term delivery. In extreme cases it can lead to foetal or maternal death. Clinical teams inevitably have a high degree of suspicion for the disease and a low threshold to admit pregnant women with suspected PE. This places significant economic and capacity burdens on maternity systems. It costs the NHS an estimated £9,000 per pregnancy to treat. Up to now there has been no definitive way to accurately diagnose who is not at risk of developing pre-eclampsia. Women are routinely admitted for an anxious few days of hospital tests ‘just in case’ – but most do not actually have the condition.

How is the AHSN involved?

In 2017, the Oxford AHSN initiated a project to drive the uptake and adoption of placental growth factor-based (PlGF) testing. Working with the Oxford Patient Safety Collaborative and clinical leads, laboratory heads, finance and management functions, the Oxford AHSN was successful in helping the first three hospital trusts in England adopt PlGF-based testing into standard clinical practice.

The Oxford AHSN has now developed an implementation pack to support the adoption and spread of PlGF-based testing.

Following a rigorous selection process, the test has been selected for rapid uptake nationally through the NHS England Innovation Technology Payment scheme and Accelerated Access Collaborative, which identify highly transformative innovations and introduce an accelerated pathway to market. All AHSNs are now working together to ensure rapid and widespread adoption of the test into standard clinical practice in maternity units across the country.

Impacts / outcomes of AHSN involvement to date

AHSNs are leading a rapid roll out into maternity units across the country enabling faster and more accurate diagnosis. This is making the pre-eclampsia test available to thousands more pregnant women – up from 29,000 in March 2019 to a predicted 200,000+ by the end of December 2019.

Detailed implementation packs have been developed covering changes required to pathways and practices. These make it relatively straightforward to replicate at any maternity unit which is supported by a laboratory.

A collaborative, multi-disciplinary approach is enabling improved decision-making, clinical risk reduction and better targeting of resources. This in turn is leading to improvements to patient safety, experience and satisfaction.

For each hospital AHSNs are developing insight into their unique pathway and needs and providing project management and business support behind the adoption process.

Positive impacts include:

  • Improved patient safety through accurate diagnosis on the suspicion of PE
  • Reduction in the number of (unnecessary) admissions for suspected PE
  • Improvement in maternity capacity as the result of having fewer women to monitor as inpatients
  • Improvement in community midwifery capacity due to a reduction in the number of follow-on appointments required once PE is suspected
  • A reduction in the direct costs to the system from the array of inpatient monitoring tests undertaken on the woman and her foetus. Of note is the ability to keep a woman on the most appropriate treatment pathway (i.e. Standard, Intermediate or Intensive) and not to have to escalate the level of her care to a higher pathway during the pregnancy upon the suspicion of PE, for which no additional funds are made available
  • A reduction in the number of pre-term or emergency deliveries (delivery of the baby is the only “cure” for PE)
  • Positive impact on workload and costs incurred by both maternity and paediatric services as a result of fewer pre-term births – cost savings based on fewer outpatient visits, admissions, pre-term deliveries and less onward neonatal care – projected savings in England are expected to be in the region of £4m per year, based on an estimated saving of £250-£600 per woman tested projected from health economic models.

There is also growing international interest in adopting this model; clinical and laboratory leaders from the original UK adopting Trust are providing support to adopting hospitals abroad.

This NHS/research/industry partnership has won national and international awards, including from the HSJ and the UNIVANTS of Healthcare Excellence.

Through the work with Oxford AHSN on this and other projects, Roche Diagnostics also estimate that around 6 jobs have been safeguarded across England.

Learning to date

Key to the success of the project is confirmation of local clinical need, drivers and priorities in each hospital, mapping current and future clinical pathways with associated costs and benefits.

To successfully deliver the project, key internal stakeholders (e.g. labs, finance) who are required to approve and then implement the adoption of the new test and pathway have to be identified and engaged early on in the process.

As with most diagnostic tests, simply adopting the test into existing clinical or patient pathways will likely add cost with limited additional benefit for the clinical team or pregnant women under their care. As such, clinical and laboratory teams must adopt new pathways to incorporate PlGF-based testing into standard clinical care. Example pathways are available through the AHSN Network.

Plans / timescales for adoption and spread

Having worked through the Oxford Patient Safety Collaborative to achieve initial adoption in three maternity units in the Oxford AHSN region, PlGF-based testing to aid in the diagnosis of suspected pre-eclampsia was selected for funding under both the Innovation Technology Payment (ITP) and Rapid Uptake Product (RUP) payment schemes under the Accelerated Access Collaborative (AAC) in April 2019. The project is now being delivered nationally by all 15 AHSNs, led by Oxford AHSN.

Maternity services have responded very positively to the adoption of PlGF-based testing. In the first nine months of ITP funding, it anticipated that around 50 additional NHS trusts will have adopted a test into standard clinical practice, meaning over 200,000 additional pregnant women will have a diagnostic test for PE available to them (up from 29,000 across five adopted Trusts prior to April 2019). These numbers mean that just over 40% of all maternity services in England are expected to have adopted a PlGF-based test by year end, covering just over a third of all pregnancies.

Opportunities to get involved

The opportunity to adopt PlGF-based testing to aid in the diagnosis of pre-eclampsia under ITP and RUP funding is available to all maternity services in England until the end of September 2020. If you would like to know more about PlGF-based testing, please contact Oxford AHSN via the contact details below or your local AHSN.

Start and end dates

2017-ongoing.

Project contact for further information

Guy Checketts, Programme Lead for Diagnostics, Oxford AHSN

E: guy.checketts@oxfordahsn.org

Media contact for further information

Martin Leaver, Head of Communications

E: martin.leaver@oxfordahsn.org