Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2026
Summary
Improve pregnancy outcomes for pregnant women living in Blackwater with multiple/ complex psychosocial risk factors through early access to antenatal care in the Central Highlands.
Dates: 1 February 2025 - ongoing
Implementation sites: Emerald Hospital
This project was presented as a Poster at CEQ Showcase 2026 (PDF 275KB).
Aim
To implement a streamlined Emergency Department (ED) antenatal fast-track referral pathway that ensures timely, equitable and culturally safe access to specialist maternity care for pregnant women living in Blackwater.
Outcomes
- No unplanned births at Blackwater MPHS for women who have accessed the ED-AN Fast Track referral.
- Reduction in system delays compared to GP referral model
- Improved early engagement of pregnant women.
- The recruitment of an Identified Midwife Navigator also bolstered this referral pathway as there was increased capability to recognise and address barriers with these vulnerable women.
- Development of safe trusting relationships
- Improved engagement beyond pregnancy
- Engagement that empowers women
Background
- Emerald Hospital Maternity supports ANC across the Central Highlands. The Emerald Hospital birthing service is equipped for low-risk pregnancies only and is supported by Rural Generalist Senior Medical Officers with advanced skills in obstetrics.
- Emerald Hospital births totalled 270 in 2024 and 302 in 2025. Of these some were BW residents.
- Of the total births, due to shared care and high- risk pregnancies, the Emerald Hospital Maternity service coordinates significantly more antenatal care in comparison to births of local women.
- High risk pregnancies are coordinated by Emerald Maternity to ensure clinical oversight and safe birthing options are explored for the women's individual needs.
- Incidental identification of birthing women who are accessing Emergency Departments in the Central Highlands permitted opportunity for early recognition of women who may have multiple or complex psychosocial risk factors impacting their ability to access ANC.
- This referral enabled opportunistic referral to ANC services, commencement of routine screening with no out of pocket costs and introduction to the maternity service and models of care available for women to access.
- Early recognition and support of such women was being offered in Emerald Emergency Department with the introduction of the ED-AN Fast Track in 2023, with success.
- Blackwater Multipurpose Health Service (MPHS) is located 77km from the closes birthing service, Emerald Hospital. Blackwater MPHS has 24/7 Emergency Department, four residential aged care beds and four acute inpatient beds.
- Several episodes of care noted at Blackwater MPHS Emergency Department in late 2024 identified presentations of late gestation pregnancies, high risk factors with limited to no ANC. This was of concern to Blackwater MPHS clinicians for patient safety and also to the Emerald Maternity team in regard to access to safe and relevant services.
- It was also noted that there had been an increase in maternity activity noted, particularly high risk and complex birthing women in the town of Blackwater with limited access to ANC, GPs and bulk billing and non-government organisations.
- Consideration about the application of this referral pathway and access to an ANC service was discussed with Emerald Maternity and Director of Nursing at Blackwater MPHS. It was agreed that any facilitation to support access to ANC for these women would be beneficial.
- The recruitment of an Identified Midwife Navigator also bolstered this referral pathway as there was increased capability to recognise and address barriers with these vulnerable women.
Methods
PLAN
- Consultation with key stakeholders - Emerald Maternity Nurse Educator, Emerald Maternity Obstetric SMOs, Emerald Maternity Unit Manager, Central Highlands Child Protection Liaison Officer, Midwife Navigator and Director of Nursing at Blackwater MPHS.
- It was agreed that any facilitation to support awareness of non-engaged and/or high-risk pregnancies in Blackwater would be beneficial for patient safety and birthing women's outcomes.
- Emerald ED-AN Fast Track flow diagram reviewed to ensure this referral pathway would be suitable for Blackwater MPHS ED to adopt.
- Emerald ED-AN Fast Track PowerPoint presentation and case studies reviewed to ensure stability for Blackwater implementation education.
DO
Referral folder compiled as resource for ED Blackwater which included:
- Referral flow diagram
- ANC pre-populated pathology form
- ANC pre-populated USS request form
- Mid-wife navigator referral form
- ED-AN Fast Track referral education provided to all Blackwater MPHS clinicians and support staff e.g. Indigenous Hospital Liaison Officer.
STUDY
- Improve clinical safety by enabling earlier maternity involvement and reducing delays in assessment.
- Address inequity for vulnerable antenatal patients, including those with psychosocial concerns, women living rurally or remotely, and those with limited health literacy who may struggle to access appropriate services.
- Reduce ED burden and prevent bottlenecks by ensuring patients are cared for in the most suitable clinical environment.
- Support continuity of care and earlier connection to maternity services, improving both maternal and fetal outcomes.
- Enhance patient experience by minimising wait times and reducing anxiety in an unfamiliar clinical environment.
ACT
- Upon review of the ED-AN Fast Track referral, the pathway has been altered to ensure the Midwife Navigator receives the referral in the first instance so there is timely action of the referral including initial contact with the pregnant women. Previously the referral was sent via the routine ANC referral pathway, needed triaging and appointment scheduling before intervention commenced.
- Qualitative feedback is sought routinely from all ED-AN Fast Track referral women postnatally as a component of the midwife navigator discharge. Stories are shared and in some instances permission has been granted to share de-identified patient journeys.
Discussion
The implementation of the ED-AN Fast Track referral was only successful due to the shared goal of the Emerald Maternity Team, CPLO, Midwife Navigator and Blackwater MPHS clinicians to ensure safe and supported access to ANC and birthing for pregnant women residing in Blackwater.
The success of this pathway to support pregnant women in Blackwater was heavily reliant upon the appointment of the Midwife Navigator.
This referral pathway could absolutely be considered for application across Queensland Health.
References
N/A
Key contact
Kady Colman
Identified Midwife Navigator
Central Queensland Hospital and Health Service