Hans van den Heuvel

Survey results Out of 73 invitations, 57 hospitals participated in the online survey (response rate 78%). Of these 57 respondents, 26 (45%) worked in a teaching hospital, 22 (39%) in a non-teaching hospital and 9 (16%) in an tertiary care hospital with neonatal intensive care unit. Of the responding 57 hospitals, 8 (14%) had 0-1000 births/year, 29 (51%) 1001-2000 births/year, 18 (32%) 2001-3000 births/year and 2 (3%) over 3000. Declining trend of home monitoring Six units (11%) did offer home monitoring in the years between 1995-2018 but stopped performing pregnancy monitoring with home visits. Median number of years of home monitoring provision was 7.5 years (range 2-18 years). Several reasons for their discontinuation were given, such as: small number of possible candidates (3/6), problems with staff capacity (3/6), problems with the financial capacity to continue home monitoring (2/6) and switching over to telemonitoring without home visits (2/6). Eight of 19 hospitals with home monitoring (42%) considered switching to telemonitoring, stating that it seems to contribute tomore patient satisfaction and it does not require hospital staff to visit patients at home. Three hospitals providing home monitoring did not consider to change to telemonitoring because they are satisfied with their current home monitoring strategy. With telemonitoring, they stated, there is no daily direct clinical assessment of the patient by a nurse/midwife and no possibility to monitor twin pregnancies. Evaluation of use In 12/19 hospitals with home monitoring (63%), implementation of home monitoring was not preceded by a center-specific evaluation phase of home-monitoring. However, home monitoring in these centers mainly started after the publication of two Dutch trials concluding its patient safety and positive effects on satisfaction of care.(7,8) As for telemonitoring, 6 of 17 centers (35%) were participating in a multicenter randomized controlled trial comparing clinical hospital admission with telemonitoring in pregnancies requiring daily fetal monitoring. Aimof this trial is to compare patient safety, user satisfaction and cost-effectiveness; its protocol can be found elsewhere.16 The remaining ten centers (59%) reported they did not participate in nor started evaluation of use of this novel strategy with daily self-measurements prior to implementation in complicated pregnancies in their centers. Indications and management in home-based pregnancy monitoring Responding centers with either home- or telemonitoring reported similar lists of pregnancy complications, which they considered eligible for daily monitoring outside their hospital (Table 4). Both fetal growth restriction and preterm rupture of membranes are considered eligible for home- as well as telemonitoring in every center. CHAPTER 9 150