Evaluating patient experience to improve care in a specialist antenatal clinic for pregnancy after loss

Abstract

In the United Kingdom, roughly 1 in 250 babies are stillborn each year. Most women who experience stillbirth become pregnant again - 80% within a year of loss. Presently, obstetric-led care is recommended; though there is a growing body of evidence to support provision of specialist services. The Rainbow Clinic is a specialist antenatal service providing care for pregnancies after loss incorporating clinical and psychological care. This study aimed to assess patient experience at the Rainbow Clinic and identify areas for clinical improvement. A 13-item questionnaire was distributed to pregnant women who attended the Rainbow Clinics at the Oxford Road and Wythenshawe sites of Saint Mary's Hospital, Manchester, UK between July 2016 and June 2021. Descriptive statistics and unpaired t-test were used for quantitative data and summative content analysis for qualitative data. Four-hundred and fifty-six women completed the questionnaire. The mean patient experience score per quarter was stable with an average of 21.1 (± 3.0) for the five years, with a maximum attainable score of 25. The COVID-19 pandemic had no effect on patient experience at the Rainbow Clinic (pre-pandemic vs. during-pandemic: mean 21.2 v 21.3; p = 0.75). Free-text responses demonstrated women felt positively about the antenatal care received. Identified areas for improvement included "more awareness of the [Rainbow] sticker" to ensure women with previous loss are identified; increased publicity of the Rainbow Clinic services; developing more clinics at different locations to improve accessibility; and continuing specialist input into intrapartum care. Specialist antenatal care provided by the Rainbow Clinic was rated as of a high standard. Potential future improvements include sticker alterations (or other mechanisms to identify women who have experienced a previous loss) and develop increased awareness of the clinic in other institutions.

Keywords: Antenatal care; Experience; Pregnancy; Questionnaire; Rainbow clinic; Stillbirth.

Fig 1

Impact of time on the overall patient experience score in women attending the Rainbow Clinic. The number of completed questionnaires for each quarter year is written in red. The maximum achievable score is 25. Mean and standard deviation (SD) for each quarter year is shown

Fig 2

A bubble diagram of codes from free-text responses of the last question of the questionnaire. In total, there were 622 codes from patient responses. The area of each circle corresponds to the frequency of the code. Colours: pink = positive codes; purple = areas which participants identified for improvement; orange = negative codes