Raised blood pressure readings are frequently encountered in the antenatal clinic out-patient setting, but do not always reflect actual or impending preeclampsia (PE).
To clarify the possibility of actual or impending PE, one common approach is a short stay (4 hour) admission to a Pregnancy Day Care Centre (PDCC) for blood pressure monitoring and and relevant laboratory testing.
Often, significant PE is diagnosed in only a minority of women as a result of such PDCC review, in which case they are then admitted for on-going inpatient ward care.
On the other hand, the majority of PDCC reviews for suspected PE often have sequential visits for blood pressure and test monitoring in order to confirm or exclude a diagnosis of PE.
This approach is resource intensive, with currently available laboratory tests showing poor predictive value for the diagnosis of PE. It also burdens the woman and her family with diagnostic uncertainty and repeated hospital visits.
Recent research has demonstrated the value of the sFLT-1/PIGF ratio blood test for predicting PE.
An audit was therefore undertaken comparing the standard PDCC admission regimen with the use of the sFLT-1/PIGF ratio test in 197 women admitted for suspected PE to the Royal Women's Hospital PDCC over a 4 month period.
As part of this audit, a budget impact assessment was performed which compared current PDCC cost/revenue figures for such admissions with an alternate model involving initial testing using the ratio, with those testing "low risk" continuing as outpatients rather than being admitted to PDCC.
This analysis suggested use of the ratio test in this way would potentially reduce such admissions by 65%, generate a potential direct budgetary benefit of over $50,000 pa, and improve patient experience by reduced hospital visits and improved diagnostic certainty, without compromising clinical care standards or patient safety.