Utilising Women's Health Australasia Benchmarking Data in a Meaningful Way Christchurch Women's Hospital: number 43
Download ReportTranscript Utilising Women's Health Australasia Benchmarking Data in a Meaningful Way Christchurch Women's Hospital: number 43
Slide 1
Utilising Women's Health Australasia
Benchmarking Data in a Meaningful Way
Christchurch Women's Hospital: number 43
Slide 2
Utilising Women's Health Australasia
Benchmarking Data in a Meaningful Way
•Assessing the data, making it meaningful for our service
•Bring the right people together
•Independent commentary (Prof David Ellwood)
•Action/Aims
•Desired Outcomes
•Formulating a Plan
Slide 3
2000
4000
6000
Level 6 Maternity Care
Level 1-5 Maternity Care
0
total num ber of wom en giv ing birth 2009-10
8000
Figure 1: Total number of women giving
birth by any method (2009-10)
57 29
9
47 32 63 11 62 35 42 59 55 31 33 21 49 48 56 52 19
Hospital ID
3
30 25 43
7
27 18 22
Slide 4
All WHA members ( 29.2 per 100 )
Level 6 Maternity Care ( 29.4 per 100 )
Level 1-5 Maternity Care ( 28.8 per 100 )
Level 6 Maternity Care
Level 1-5 Maternity Care
40
40
Figure 4: % women giving birth by
caesarean section (2009-10)
35
59
35
35
36.1
35.1
32
7
34.4
32.7
32.6
32.5
43
33.3
33
9
19
31
27
18
31.5
63
30
30
30.6
30.2
29.4
29.2
29.2
29
42
21
47
28.6
28.5
28.5
28.3
28.3
49
48
57 29
25
52
30
3
27.5
62
11
25
25
26.8
26.7
33
24.4
55
56
20
23.6
23.3
20
% w omen giv ing birt h by c aes arean s ec t ion (2009-10)
38
22
17.2
22 56 55 33 11 62
3
30 48 57 29 52 49 25 47 21 42 63 18 31 19
Hospital ID
9
27 43
7
32 59 35
2000
4000
6000
Total number of women giving birth (2009-10)
8000
Slide 5
All WHA members ( 17 per 100 )
Level 6 Maternity Care ( 17.9 per 100 )
Level 1-5 Maternity Care ( 15.1 per 100 )
Level 6 Maternity Care
Level 1-5 Maternity Care
32
24.9
25
25
26.6
43
19
24.1
27
23.5
49
7
20
20
20.8
20.4
19.9
19.6
19.3
35
17.7
17.5
17.3
18
3
9
4231
16.6
16.6
16.5
14.8
25
21
33
15
15.5
15
30
62
59
18.7
18.6
29
63
14.2
57
13.6
13.6
13.3
48
52
11
12.2
56
11.2
10
10.3
10
% w omen w ho gav e birth v aginally w it h f inal as s is t anc e f rom eit her forc eps or v ac uum (2009-10)
Figure 7: % women giving birth vaginally where
either forceps or vacuum extraction was used
as the final method of birth (2009-10)
47
55
8.8
22
7.7
22 55 47 56 11 48 52 57 63 29 33 31 21 42
9
3
Hospital ID
25 18 59 35 62 30
7
49 27 19 43 32
1000
2000
3000
4000
5000
Total number of women giv ing birth vaginally (2009-10)
6000
Slide 6
All WHA members ( 8.81 per 100 )
Level 6 Maternity Care ( 8.82 per 100 )
Level 1-5 Maternity Care ( 8.77 per 100 )
Level 6 Maternity Care
Level 1-5 Maternity Care
31
12
12
12.1
32
11.1
35
9.8
9.9
10
19
25
10
10
10.510.5
10.3
10.1
3
59
7
42
9.7
27
18
9.4
30
9.2
8.9 8.9
9
9
9
29
9
63
62
21
52
8
8
8.6
7.6
7.4
7.7
7.5
33
57
43
48
55
6
6
6.9
11
5.1
22
4.5
4
4
% of women who have had a previous primary caesarean section (2009-10)
Figure 17: % women giving birth with only one
previous primary caesarean section (VBAC
eligible) (2009-10)
22
11
55
57
33
48
43
52
62
21
63
29
9
30
Hospital ID
18
42
7
27
59
3
25
19
35
32
31
2000
4000
6000
Total number of women giv ing birth (2009-10)
8000
Slide 7
All WHA members ( 48.8 per 100 )
Level 6 Maternity Care ( 49.6 per 100 )
Level 1-5 Maternity Care ( 46.4 per 100 )
80
80
Level 6 Maternity Care
Level 1-5 Maternity Care
29
73.3
66.767.1
18
63
25
60
60
63
35
55.9
55.255.6
30
55
22
52.953.4
46.346.5
47
599
11
62
44
43 43.143.6
42
19
33
7
52
40
40
42.1
41.4
27
32
50.8
37.137.4
43
48
3
34.6
33.3
57
20
20
% of V B A C -eligible w omen w ho at temped labour and had a v aginal birt h (2009-10)
Figure 20: % VBAC-eligible women,
who attempted labour, who gave birth
vaginally (2009-10)
57
3
48
43
52
7
42
33
19
62
11
9
59
Hospital ID
32
27
22
55
30
35
25
63
18
29
50
100
150
200
250
Total number of VBAC-eligible women who attempted labour (2009-10)
300
Slide 8
Figure 22: % selected primiparas giving birth
having an induction of labour (2009-10)
40
40
Level 6 Maternity Care
Level 1-5 Maternity Care
30
39.2
38.7
59
25
35
35
37
7
34.4
29
32.8
49
30
30
31
30
29.729.8
27
48
27.8
11 3256
2727.127.2
9
26.4
31
25
25
25.6
33
23.7
22.8
23
55
21
62
20
20.6
20.2
19.9
20
18
3
35
28.9
43
42
19.1
18.7
19
52
63
17.6
57
15
16.1
15
% s elec t ed primiparas hav ing induc t ion of labour (2009-10)
All WHA members ( 26.7 per 100 )
Level 6 Maternity Care ( 27.8 per 100 )
Level 1-5 Maternity Care ( 24.3 per 100 )
15.2
22 57 63 19 52 42 43 62 55 21 33 31
9
56 11 32 48 27 35
Hospital ID
3
18 49 29
7
25 59 30
22
500
1000
1500
Total number of selected primiparas giving birth (2009-10)
2000
Slide 9
Previous slides show
• High CS rates
• High instrumental
rates
• VBAC Low
• low IOL rate
•
•
•
•
•
×
×
×
×
√
Slide 10
Where to from here?
1. Recognise we may have an issue with our clinical
outcomes.
2. Look deeper into the reasons behind this (audit).
3. Transparency is key here and buy in from the
Clinical Director and leads.
4. Organise an independent review of the data.
5. Present the data in an informative supportive way to
the service.
6. Decide if the outlier issues raised are a priority and
as a service plan how to change the situation.
Slide 11
What we are doing?
• Conscious decisions have been made
• More supervision of junior staff
• Fetal blood sampling and discussion with SMO prior
to CS or instrumental delivery
• VBAC midwifery lead service
Utilising Women's Health Australasia
Benchmarking Data in a Meaningful Way
Christchurch Women's Hospital: number 43
Slide 2
Utilising Women's Health Australasia
Benchmarking Data in a Meaningful Way
•Assessing the data, making it meaningful for our service
•Bring the right people together
•Independent commentary (Prof David Ellwood)
•Action/Aims
•Desired Outcomes
•Formulating a Plan
Slide 3
2000
4000
6000
Level 6 Maternity Care
Level 1-5 Maternity Care
0
total num ber of wom en giv ing birth 2009-10
8000
Figure 1: Total number of women giving
birth by any method (2009-10)
57 29
9
47 32 63 11 62 35 42 59 55 31 33 21 49 48 56 52 19
Hospital ID
3
30 25 43
7
27 18 22
Slide 4
All WHA members ( 29.2 per 100 )
Level 6 Maternity Care ( 29.4 per 100 )
Level 1-5 Maternity Care ( 28.8 per 100 )
Level 6 Maternity Care
Level 1-5 Maternity Care
40
40
Figure 4: % women giving birth by
caesarean section (2009-10)
35
59
35
35
36.1
35.1
32
7
34.4
32.7
32.6
32.5
43
33.3
33
9
19
31
27
18
31.5
63
30
30
30.6
30.2
29.4
29.2
29.2
29
42
21
47
28.6
28.5
28.5
28.3
28.3
49
48
57 29
25
52
30
3
27.5
62
11
25
25
26.8
26.7
33
24.4
55
56
20
23.6
23.3
20
% w omen giv ing birt h by c aes arean s ec t ion (2009-10)
38
22
17.2
22 56 55 33 11 62
3
30 48 57 29 52 49 25 47 21 42 63 18 31 19
Hospital ID
9
27 43
7
32 59 35
2000
4000
6000
Total number of women giving birth (2009-10)
8000
Slide 5
All WHA members ( 17 per 100 )
Level 6 Maternity Care ( 17.9 per 100 )
Level 1-5 Maternity Care ( 15.1 per 100 )
Level 6 Maternity Care
Level 1-5 Maternity Care
32
24.9
25
25
26.6
43
19
24.1
27
23.5
49
7
20
20
20.8
20.4
19.9
19.6
19.3
35
17.7
17.5
17.3
18
3
9
4231
16.6
16.6
16.5
14.8
25
21
33
15
15.5
15
30
62
59
18.7
18.6
29
63
14.2
57
13.6
13.6
13.3
48
52
11
12.2
56
11.2
10
10.3
10
% w omen w ho gav e birth v aginally w it h f inal as s is t anc e f rom eit her forc eps or v ac uum (2009-10)
Figure 7: % women giving birth vaginally where
either forceps or vacuum extraction was used
as the final method of birth (2009-10)
47
55
8.8
22
7.7
22 55 47 56 11 48 52 57 63 29 33 31 21 42
9
3
Hospital ID
25 18 59 35 62 30
7
49 27 19 43 32
1000
2000
3000
4000
5000
Total number of women giv ing birth vaginally (2009-10)
6000
Slide 6
All WHA members ( 8.81 per 100 )
Level 6 Maternity Care ( 8.82 per 100 )
Level 1-5 Maternity Care ( 8.77 per 100 )
Level 6 Maternity Care
Level 1-5 Maternity Care
31
12
12
12.1
32
11.1
35
9.8
9.9
10
19
25
10
10
10.510.5
10.3
10.1
3
59
7
42
9.7
27
18
9.4
30
9.2
8.9 8.9
9
9
9
29
9
63
62
21
52
8
8
8.6
7.6
7.4
7.7
7.5
33
57
43
48
55
6
6
6.9
11
5.1
22
4.5
4
4
% of women who have had a previous primary caesarean section (2009-10)
Figure 17: % women giving birth with only one
previous primary caesarean section (VBAC
eligible) (2009-10)
22
11
55
57
33
48
43
52
62
21
63
29
9
30
Hospital ID
18
42
7
27
59
3
25
19
35
32
31
2000
4000
6000
Total number of women giv ing birth (2009-10)
8000
Slide 7
All WHA members ( 48.8 per 100 )
Level 6 Maternity Care ( 49.6 per 100 )
Level 1-5 Maternity Care ( 46.4 per 100 )
80
80
Level 6 Maternity Care
Level 1-5 Maternity Care
29
73.3
66.767.1
18
63
25
60
60
63
35
55.9
55.255.6
30
55
22
52.953.4
46.346.5
47
599
11
62
44
43 43.143.6
42
19
33
7
52
40
40
42.1
41.4
27
32
50.8
37.137.4
43
48
3
34.6
33.3
57
20
20
% of V B A C -eligible w omen w ho at temped labour and had a v aginal birt h (2009-10)
Figure 20: % VBAC-eligible women,
who attempted labour, who gave birth
vaginally (2009-10)
57
3
48
43
52
7
42
33
19
62
11
9
59
Hospital ID
32
27
22
55
30
35
25
63
18
29
50
100
150
200
250
Total number of VBAC-eligible women who attempted labour (2009-10)
300
Slide 8
Figure 22: % selected primiparas giving birth
having an induction of labour (2009-10)
40
40
Level 6 Maternity Care
Level 1-5 Maternity Care
30
39.2
38.7
59
25
35
35
37
7
34.4
29
32.8
49
30
30
31
30
29.729.8
27
48
27.8
11 3256
2727.127.2
9
26.4
31
25
25
25.6
33
23.7
22.8
23
55
21
62
20
20.6
20.2
19.9
20
18
3
35
28.9
43
42
19.1
18.7
19
52
63
17.6
57
15
16.1
15
% s elec t ed primiparas hav ing induc t ion of labour (2009-10)
All WHA members ( 26.7 per 100 )
Level 6 Maternity Care ( 27.8 per 100 )
Level 1-5 Maternity Care ( 24.3 per 100 )
15.2
22 57 63 19 52 42 43 62 55 21 33 31
9
56 11 32 48 27 35
Hospital ID
3
18 49 29
7
25 59 30
22
500
1000
1500
Total number of selected primiparas giving birth (2009-10)
2000
Slide 9
Previous slides show
• High CS rates
• High instrumental
rates
• VBAC Low
• low IOL rate
•
•
•
•
•
×
×
×
×
√
Slide 10
Where to from here?
1. Recognise we may have an issue with our clinical
outcomes.
2. Look deeper into the reasons behind this (audit).
3. Transparency is key here and buy in from the
Clinical Director and leads.
4. Organise an independent review of the data.
5. Present the data in an informative supportive way to
the service.
6. Decide if the outlier issues raised are a priority and
as a service plan how to change the situation.
Slide 11
What we are doing?
• Conscious decisions have been made
• More supervision of junior staff
• Fetal blood sampling and discussion with SMO prior
to CS or instrumental delivery
• VBAC midwifery lead service