Author: Jason Curtis

Obstetric Bleeding Study UK (OBS UK): protocol for a stepped wedge cluster randomised trial investigating the clinical and cost-effectiveness of a maternity quality improvement programme to reduce excess bleeding and need for transfusion after childbirth (2026)

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Type of publication:

Journal article

Author(s):

Kotecha S.J.; Potter C.; Hope-Bell J.; Riddell N.S.; Munnery K.; Onyimadu O.; Liberty C.; Taylor H.; Dop C.; De Lloyd L.; *Parry-Smith W.; Townson J.; Pallmann P.; Moody G.; Moriarty Y.; Deere R.; Barlow C.; Dhadda A.; *Elsmore A.; Willson S.; *Millward H.; *Siddall K.; Sanders J.; Stanworth S.J.; Black M.; Petrou S.; Rai T.; Slade P.; Hinton L.; Fye H.; Gur Geden A.; Collis R.E.; Collins P.; Bell S.

Citation:

BMJ open. 16(8) (pp e118723), 2026. Date of Publication: 20 Aug 2026.

Abstract:

INTRODUCTION: Bleeding during and after childbirth (postpartum haemorrhage, PPH) is the leading cause of severe maternal morbidity in the UK. Between 2017 and 2018, a PPH care bundle termed the Obstetric Bleeding Strategy (OBS) was implemented as a quality improvement project across all Welsh maternity units and improvements in maternal outcomes were observed. The OBS PPH care bundle incorporates assessment of bleeding risk, real-time cumulative quantification of blood loss, escalation of multiprofessional care including more senior staff at defined volumes of blood loss and point-of-care testing of coagulation at 1 L blood loss (or earlier if clinical concern) with targeted blood product transfusion in cases of haemostatic impairment. The Obstetric Bleeding Study UK (OBS UK) will evaluate this intervention in a larger number of maternity units across the UK. METHODS AND ANALYSIS: OBS UK is a stepped wedge cluster randomised trial designed to test the effectiveness of the OBS intervention compared with usual care on clinical and psychological PPH outcomes after childbirth, evaluate its cost-effectiveness and perform a process evaluation. The study will be capturing data from over 270 000 women and birthing people giving birth in the care of 36 participating maternity units during the 30-month study period. All maternity units will undertake a control period (lasting 3-18 months) during which usual PPH care will be provided, followed by a 9-month implementation period during which the OBS PPH care bundle will be introduced using quality improvement methods and then an OBS UK intervention period (lasting 3-18 months) during which OBS PPH care will be delivered.The primary outcome is the number of women receiving allogeneic red blood cell transfusion for PPH per 1000 maternities. Secondary outcomes are informed by the core PPH outcome set, psychological and cost-effectiveness measures for women and their partners and a mixed methods process evaluation exploring how the intervention was deployed and possible improvements to inform wider implementation. ETHICS AND DISSEMINATION: OBS UK will establish whether (and how) the OBS UK PPH care bundle improves outcomes and experiences of women and their partners. Published results will provide evidence to inform PPH maternity care across the UK and internationally. Dissemination of the findings will be made available to members of the public and participants. TRIAL REGISTRATION NUMBER: ISRCTN17679951

DOI: 10.1136/bmjopen-2026-118723

Link to full-text [open access - no password required]

The volume-outcome relationship for incisional hernia repair: analysis of an administrative dataset for England (2026)

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Type of publication:

Journal article

Author(s):

Monaghan M.; *Cheetham M.; Thomas R.; Parker S.; Briggs T.W.R.; Gray W.K.

Citation:

Hernia. 30(1) (no pagination), 2026. Article Number: 322. Date of Publication: 01 Dec 2026 [epub ahead of print]

Abstract:

Purpose: Incisional hernia is a common complication following abdominal surgery and repair can be complex. We aimed to use an administrative dataset for England to investigate the relationship between surgeon and provider volumes and outcomes. Method(s): We used data from the Hospital Episodes Statistics database for adult incisional hernia repair conducted in England from 1st April 2013 to 31st March 2025. The exposure variables were annual surgeon and provider volume defined as the number of procedures conducted in the 12 months prior to the index procedure. The primary outcome was reintervention surgery within two-years. Secondary outcomes were reintervention surgery at one and five years, length of stay greater than the median, 30-day all-cause emergency readmission and post-surgery complications. The relationship was modelled using multilevel, multivariable logistic regression with adjustment for prespecified covariates. Result(s): Data were available for 75,664 incisional hernia repairs conducted by 4355 surgeons within 165 providers. There was a significant relationship between greater surgeon annual volume and lower rates of reintervention surgery at two years (OR 0.995 (95% CI 0.992 to 0.998), p = 0.002) and five years (OR 0.994 (95% CI 0.991 to 0.997), p < 0.001) and between greater hospital provider volume and stay greater than the median (OR 1.001 (95% CI 1.000 to 1.002), p = 0.004). There was no relationship between volume and other short-term surgical outcomes. Conclusion(s): A relationship exists between lower surgeon volume and higher rates of reintervention surgery for incisional hernia repair. There was no relationship between lower surgeon or provider volume and poorer peri-surgical complications. Setting minimum surgeon annual volume thresholds may help to improve repair rates.

DOI: 10.1007/s10029-026-03827-z

A systematic review of clinical outcome reporting in randomised controlled trials evaluating remote obstetric antenatal monitoring (2026)

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Type of publication:

Conference abstract

Author(s):

Le Vance J.; Man R.; *Adeoye A.; Amaranathan S.; Massey S.; Gurney L.; Morton V.H.; Morris R.K.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BMFMS Abstracts 2026. Leeds United Kingdom. 133(Supplement 1) (pp S29), 2026. Date of Publication: 01 Aug 2026.

Abstract:

Objective: Technological innovations in remote antenatal care have expanded rapidly, aiming to shift aspects of care outside the hospital setting. However, current research objectively heralds variable outcome reporting, currently limiting meaningful comparison. This review systematically examined the heterogeneity of outcome reporting in remote obstetric monitoring trials and determined the need for a core outcome set (COS). Method(s): Five databases were searched from January 2015 to November 2025. Randomised controlled trials (RCTs), RCT protocols and randomised pilot studies evaluating any remote antenatal monitoring device with an appropriate comparator were included. Outcomes and their timing were extracted verbatim by two reviewers. Duplicate and similarly worded outcomes were removed, and outcome variability was assessed by the number of unique outcomes reported. Outcomes were categorised into domains. Result(s): Forty studies were included: 24 (60%) RCTs, 10 (25%) RCT protocols and 6 (15%) pilot RCTs. Blood pressure (17, 42.5%) and blood glucose monitoring (16, 40.0%) were the most frequently used technologies, with 19 studies (47.5%) employing multiple monitoring devices. Across all studies, 1,004 verbatim outcomes were reported, of which 11% (113) were primary outcomes. No single outcome was reported in all studies. After de-duplication, 361 unique outcomes remained, grouped into 73 domains. Glycaemic monitoring demonstrated the greatest definitional variation, with 29 distinct definitions. When stratified by measurement time-points, outcomes increased to 1,210, with fewer than 6% assessed beyond three months postpartum. Conclusion(s): This review demonstrated the current variability in consistent outcome reporting for remote antenatal monitoring trials. A COS is recommended for standardising outcome reporting.

DOI: 10.1111/1471-0528.70283

Coeliac Pneumococcal Vaccination (2025)

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Type of publication:

Service improvement case study

Author(s):

*Riddhika Chakravartty, *Rebekah Tudor

Citation:

SaTH Improvement Hub, November 2025

SMART Aim:

To identify all patients in the practice with a diagnosis of coeliac disease who did not have a recorded pneumococcal vaccination, and to improve vaccination uptake over a one-month period.

Link to PDF poster

Improving Weight Documentation on Paediatric Discharge Summaries (2025)

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Type of publication:

Service improvement case study

Author(s):

*Dr Caitlyn Randles, *Dr Dima Abdelhafiz, *Dr Edikan Udonyah, *Dr Susan Muniu

Citation:

SaTH Improvement Hub, December 2025

SMART Aim:

I will improve the accuracy and completeness of weight documentation on Paediatric Discharge Summaries by 01/12/25 as evidenced by a three-cycle quality improvement project.

Link to PDF poster

Part 1: Small Bowel Capsule Endoscopy (2026)

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Type of publication:

Service improvement case study

Author(s):

*Giorgia Paparella

Citation:

SaTH Improvement Hub, February 2026

SMART Aim:

To increase the percentage of patients meeting the European Society of Gastrointestinal Endoscopy (ESGE) recommendations for adequate mucosal visualisation (≥ 95%) by 10% by June 2026.

Link to PDF poster

QIP: Investigations in pneumonia (2026)

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Type of publication:

Service improvement case study

Author(s):

*Dr Owen Meurig Jones, *Dr Nicola Rowe.

Citation:

SaTH Improvement Hub, January 2026

SMART Aim:

To improve investigation and follow-up in community-acquired pneumonia, including the proportion having requests for follow-up Chest X-rays and the proportion having a HIV test performed.

Link to PDF poster