Alcohol-Induced Early-Stage Liver Injury Contributes to Increases in Voluntary Alcohol Intake and Cognitive Deficits in Mice.

Across Australia, hospitals are accredited according to their compliance with the eight to ‘protect the public from harm and to improve the quality of health service provision’ []. Standard 8 refers to recognising and responding to the acutely deteriorating patient []. In most hospitals, deterioration and escalation of care occurs in response to recordings of biophysical parameters on observation charts, including blood pressure, heart rate, respiratory rate, body temperature, oxygen saturation levels and mental alertness. Holistic interpretation of these parameters enables detection of the development of serious illness and allows timely intervention to prevent serious harm (usually triggered by a medical emergency team [MET] code) for urgent patient review []. In hospitals with maternity services, observation charts reflect the physiological changes of pregnancy and the immediate postpartum period and use adjusted parameters compared with charts used for the non‐pregnant adult population. However, between states and territories, maternity observation charts differ across multiple parameters, making simple recommendations for patient care difficult. This became apparent to our author group when writing a recent position statement on the maternity management of sepsis for the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) []. The rate of maternal deaths from sepsis has remained stagnant across Australia and New Zealand for more than 20 years []. Identifying pregnant and postpartum women with potential sepsis remains paramount []. The thresholds for abnormal observations that would trigger assessment and recognition of sepsis in a maternity patient, such as an elevated heart rate or respiratory rate, differ across states and territories. There is no clinical basis for this variation. States and territories have been responsible for generating their own maternity charts and so a national collaborative process has not occurred, with multiple chart variations existing as a result. We highlight below the potential dangers of this and the advantages of having a single national Maternity Early Warning System (MEWS) chart, as well as how development of such a chart could occur. In the process of writing this article, we submitted a request asking the Australian Commission on Safety and Quality in Healthcare to consider reviewing Standard 8 (recognising and responding to acute deterioration) specifically to develop a national MEWS chart. Vital signs are a critical part of clinical guidelines as they promote the recognition of common pathologies that result in significant maternal and neonatal morbidity, such as maternal sepsis and hypertensive disorders of pregnancy. The degree of abnormality between vital signs to trigger a clinical review and escalation to a MET response for abnormal vital signs varies significantly between states and territories. A maternal body temperature classed as fever requiring medical intervention is 38.5°C for New South Wales (NSW) and 38.0°C for South Australia [, ]. Similarly, differences exist between charts for clinical response to blood pressure. NSW defines hypertension at a systolic pressure of ≥ 140 mmHg and hypertension triggering a medical emergency response at a systolic pressure of ≥ 160 mmHg. For South Australia, the thresholds are defined as ≥ 160 and ≥ 190 mmHg. SOMANZ published (endorsed by the National Health and Medical Research Council (NHMRC)) that defines blood pressure thresholds to diagnose hypertension and severe hypertension []. To roll out national guidance and ensure safe and effective practice, standardised, evidence‐based definitions of routine clinical observations are required.