Transcript Birmingham Women’s Hospital

Birmingham Women’s
Hospital
37th Annual Clinical Report
April 2009 – March 2010
Simon Grant
Consultant in Obstetrics & Fetal Medicine
My background….
• Consultant in Obstetrics & Fetal Medicine
Southmead since 2005
• Member NICE IPC GDG 2005-7
• Consultant in Obstetrics & Gynaecology
Treliske 2000-5
• Subspecialty training in Maternal Fetal
Medicine Birmingham Women’s 1996-9
• Research Southampton 1993-5
Southmead - BWH
• Large district general hospital compared to longstanding university unit
• Full range of obstetric care except specific
maternal complications & two fetal medicine
procedures (proximal regional referral centre)
• Some limitations of gynaecology activity at both
• Developing against established research
environment
• Unusual situation in Bristol
SMH – BWH: deliveries
Hospital
SMH
07/08
BWH
07/08
SMH
08/09
BWH
08/09
SMH
09/10
BWH
09/10
5,050
7,251
5,226
7,183
5,529
5,907
571
1,184
Birth Suite
510
621
Home
209
94
209
105
192
80
Total
5,769
7,345
6,056
7,285
6,292
7,171
% Hospital
87.5
86.3
87.9
82.3
% Birth Suite
8.8
10.3
9.1
16.5
% Home Births
3.6
3.5
3.1
1.1
Maternity DAU
Other
Unknown
SMH – BWH: mode of delivery
BWH
07/08
SMH
08/09
BWH
08/09
SMH
09/10
BWH
09/10
SVD
65
61.5
62
60.1
59
Forceps
5
7
8
8
7
Ventouse
7
5.5
7
6
6
Breech
1
0.5
1
0.2
1
Elective CS
8
12.5
8
11
9
Emergency CS
14
13
15
14.5
16
108
125
132
140
2
3
2
2
%
SMH
07/08
Multiple births
Twins
Triplets
SMH – BWH: Gynaecology
SMH
07/08
BWH
07/08
SMH
08/09
BWH
08/09
SMH
09/10
BWH
09/10
New outpatients
7393
15,490
7030
16,170
Follow-up outpatients
7966
23,367
8548
25,379
Elective inpatients
1897
1311
1735
1177
1613
Elective day cases
1833
2566
2071
2413
2027
Emergencies
1694
1464
1637
1436
1613
BCRM/BWH ACU
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BCRM IVF/ICSI egg collections
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BWH ACU treatment cycles
1009
900
Scope of the report
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Clinical Governance
Maternity
Gynaecology
Neonatology
Clinical Support
Genetics
Infection Control
R&D, Education
Patient Experience
Clinical Governance (1)
• Intranet & document management system
• allows digital storage of & access to
guidelines & policies;
• facilitates update of documents;
• Challenges:
• ease of access to on-line documents
• often printed anyway for “near-patient use”
• rate limiting step for update of documents is
the process of production
Clinical Governance (2)
• NHSLA Standard 2
• considerable achievement
• what was prior level?
• admirable commitment to reassessment
against future standards
• Achievement of standards
• increasingly challenging
• is it time to reassess the system?
• BJOG December 2010
Maternity (1)
• KPIs
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80% bookings before 12 weeks
75% women with named midwife
75% continuity of carer by 2 midwives
continued increase in breastfeeding rate
smoking cessation referrals
(identification of intrauterine growth
restriction)
Maternity (2)
• First trimester combined screening for
aneuploidy
• current “gold standard” for screening
• can it be offered at the same level as in the private
sector?
• funding
• staffing
• training
• capacity
• FASP accreditation/oversight
Maternity (3)
• Community scanning
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midwife sonographers
dating & growth scans
CoGs study
improved identification of growth restriction
• Resources?
Gynaecology (1)
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Very high level of activity
Target achievement
Infection control a continued success
Successful ACU with successful pregnancy rates in line with
national standards
• Wide range of sub-speciality activity
• Urogynaecology
• Colposcopy
• Gynae cancer
• EP/AGA
• PAG
• Menopause
• MASE
Gynaecology (2)
• Assisted Conception Unit
• Multiple pregnancy rate reduced from 28% to
13%
• With no impact on overall pregnancy rates
• Significant decrease in complications of
ovarian stimulation:
• Reduction in abandoned cycles from ~12% to 03%
• Apparently significant reduction in cases of ovarian
hyperstimulation
Gynaecology (3)
• Outpatient gynaecology
• Not “just” ambulatory hysteroscopy, but includes:
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Menstrual disorders
PMB
Hysteroscopic sterilisation
OP endometrial ablation
Coil retrieval & contraceptive advice
Investigation and treatment of reproductive problems
• Innovative
• Leadership – national & wider
• Research
Neonatology
• New premises – overwhelming effort
• Joint working with BCH for neonatal
surgical patients
• Clinical information system
• Increasing nursing staffing numbers
• First submission of data to the National
Neonatal Audit Project
• Active contribution to unit’s research effort
Clinical Support (1)
• Radiology & Ultrasound
• In-house & direct access gynae US service to
GPs
• 6.5% increase in activity from 2007/8
• 41% increase in activity over 5 years up to
2009-10
• Obstetric US: 4.8/delivery (3.1/delivery @
SMH)
Clinical Support (2)
• Laboratory specialities – maintained
accreditation while dealing with increased
workload & staffing issues
• Anaesthetics:
• Epidural rate increased but still below national
average;
• Regional analgesia satisfaction rates
maintained;
• Complication rates continue to decrease
Clinical Support (3)
• Genetics:
• continued increase in staffing to address
workload;
• Meeting RTT targets.
• Infection Control:
• CQC inspection;
• 7th year of lack of any mandatory surveillance
infections.
Research & Development
• High level of stability
• long established University department
• Maintenance of staff & funding
• tenured academic posts
• support staff
• High level of activity
• 105 studies in progress, or in start-up, at the
end of March 2010
• High rate of publication
• 173 publications listed in report
“New challenges” – review 2004
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More focussed research strategy?
Recruitment to major trials?
Recruitment to specialities
Maternal morbidity
Neonatal morbidity
IUGR?
Gynaecological follow up
Challenges
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Complaints environment
First trimester screening implementation
NHSLA/CNST standards
Financial environment
Reorganisation of NHS – GP
commissioning
Annual Clinical Report 2009-10
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Extremely busy unit
High levels of clinical activity in all areas
Achieving most externally set standards
Innovative
Thriving research environment