Academic Spotlight: Dr. Laura Goodwin

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Dr Laura Goodwin is a Senior Research Fellow in Emergency Care at UWE Bristol. Her study on the temperature measurement of babies born in the pre-hospital setting has been accepted for publication in Emergency Medical Journal this week; in this interview she discusses her work on this research, her recent Showcase and Future Focus Event and her goals for the impact of her work in medical practice.

How did you come to be involved in your current area of work?

I have a PhD in Midwifery, but I work in the emergency care team; looking into prehospital birth allowed me to bring together these two areas of interest. When I looked at the literature on prehospital birth, something that really stood out to me was hypothermia and babies getting cold after prehospital birth. There wasn’t much information about why this was happening, but there was evidence to suggest that paramedics weren’t consistently recording the temperatures of babies in the prehospital setting. I decided to work with our local ambulance service, SWASFT (South Western Ambulance Service NHS Foundation Trust), to see whether it was an issue in the South West as well; the North East had done some research and there was some work from abroad, but very little research into why this inconsistency with prehospital care was happening.

I did a two-phase study. Firstly, I looked at whether temperatures were being recorded by our local ambulance service for babies born in the prehospital setting by analysing anonymised data from electronic patient care records. From this we found that less than 3% of babies had their temperature recorded; in the second phase of the study, I held interviews with paramedics to gather data on why this is the case.

What led you to this area of research?

My PhD was around inequalities in pregnancy outcomes. MBRRACE (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries) publishes a report every few years looking into maternal deaths, and another perinatal report about baby fatalities. The reports for the last decade have suggested that there are massive inequalities in outcomes; for example, black women in the UK are particularly likely to die as a result of pregnancy or childbirth, four times more likely than white women are. Other minority ethnic women and their children face similar inequalities, as do women from socially deprived backgrounds. My PhD specifically looked at the relationships in maternity care and how those could influence outcomes.

Coming into the emergency care team, I do a lot of prehospital work with paramedics to support their practice; because of the range of skills they have to cover, it’s impossible for them to be experts on everything so we are trying to give all the support we can to fill potential gaps in knowledge or gaps in confidence. I came into this area of research because it’s a combination of those two worlds, improving paramedic practice and my maternity background to fill this gap that I recognised, in supporting prehospital births. It’s been overlooked because it’s so small – only about 500 babies per year in the South West – but the outcomes can be so massive and it doesn’t take much to change it. Keeping the baby warm is a small thing we can do to have a huge impact on people.

What do you think can be done to improve the situation?

That’s the next thing I’m working on. I’m putting together a funding application at the moment which will focus on designing an intervention for paramedics. In hospitals, when they transfer babies from the neonatal unit to a ward, they often have a flowchart of things to do to ensure the baby stays warm. We’re going to look at what already exists in hospitals and try to adapt that to the prehospital setting, to give paramedics a clear action plan. There were lots of issues raised in my interviews with paramedics regarding the barriers they experience, so we’ll use some of that data and the existing hospital interventions to work with the stakeholders to find the best way to support paramedics.

What kind of barriers did you find out about from the paramedics you interviewed?

One of the main things was equipment. Most of the ambulances had a tympanic thermometer to use, but those can’t be used on babies under three months. The alternative thermometer, an underarm digital thermometer, was often missing or out of battery due to infrequent use. Another factor was that paramedics already felt that they were already doing everything possible to keep the baby warm, so taking temperature wouldn’t change their temperature management actions. The lack of understanding or awareness of the need to take temperature, to document it and act on it, links to the lack of clear pathway – paramedics didn’t know what to do if a baby was cold, what would happen, or what the lower temperature limit is for babies. Patient care records don’t have a specific box for neonatal temperature on the maternal record, which added to the belief that it didn’t need checking.

You hosted a conference recently to present these findings – how was that experience?

The event was multipurpose, to act as a dissemination event to get the information out there, but also to have people feed in new research ideas. I called it a Showcase and Future Focus Event – the aim was to share knowledge and generate new ideas from people working on the ground, who are dealing with these issues day-to-day. It was a very successful day – we actually had to close registration twice because the event became so oversubscribed! Originally we were planning to have 20-30 people for a small workshop but we ended up having over 70 people register and nearly 50 come along. I presented this work I’ve been talking about today, and then we had further presentations. We had an advanced helicopter paramedic who is part of the neonatal retrieval team come in to talk about the challenges of prehospital birth, and another presentation from a neonatal nurse consultant speaking about what happens when a baby arrives at the hospital if they’re cold. We also had some patients and some members of the public talking about their experiences, and a demonstration from a midwifery lecturer who has designed a new thermometer for the prehospital setting.

Afterwards, we had discussions about where people think the research priorities should be in prehospital birth, and we discussed the inequalities faced in this area. It was a lot of work to organise, but I got great support from my colleagues, Cathy and Alice. The event went very well, and I definitely couldn’t have done it without them.

What’s next for you?

I’m currently working on a local service evaluation which is funded by the South West Academic Health Science Network (AHSN). This work is investigating what impact this inconsistency in temperature measuring is having on babies once they arrive at hospital. Anecdotally, we know that babies often come in cold from the ambulance service, but there’s no real data to clarify this issue. I’m also looking at inequalities: are there certain groups of women who are more likely to have a prehospital birth, and does that interplay with outcome? Are there groups more at risk of a poor outcome following a prehospital birth?

The next phase of that is looking at the advice given by our call handlers when people call 999 about a prehospital birth. Sometimes by the time paramedics arrive the baby is already born, limiting the paramedic’s ability to manage the baby’s temperature effectively – they can already be very cold and therefore come into hospital cold as a result. We want to look at what advice is given when people call about this – are they being told about the importance of temperature and how to manage it? The next step in managing this is working with stakeholders to work out what advice should be given and how it should be delivered. You can read Laura’s new study here (view in the Emergency Medical Journal)– it’s well worth the read! You can connect with her via Twitter.

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