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The Health Roundtable

The Health Roundtable. Maternity Benchmarking Group Overview 28 July 2008. Today’s Agenda. Tuesday’s Agenda. Maternity Benchmarking 2008 Meetings. 28-29 March Melbourne Meeting 9 May Teleconference 28-29 July Data 6 months to December 2007, Primary Caesareans.

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The Health Roundtable

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  1. The Health Roundtable Maternity Benchmarking Group Overview 28 July 2008

  2. Today’s Agenda

  3. Tuesday’s Agenda

  4. Maternity Benchmarking 2008 Meetings • 28-29 March Melbourne Meeting • 9 May Teleconference • 28-29 July Data 6 months to December 2007, Primary Caesareans

  5. Key Outcomes Desired By Group • For the Health Service • For the Mother • For the Baby • Combination of Casemix and Survey data to review these

  6. Key Outcomes Sought • For Mothers • Meet mother expectations • Assure mothers are well-informed, prepared • Achieve high natural birth rate • Receive low complications of care • For Babies • Achieve 100% breast feeding rate • Receive low rate of serious morbidity • For Health Service • Maintain high staff retention rates • Achieve high standard of external accreditation • Maintain low rate of adverse events • Provide cost-effective services

  7. Aim Statements from March Meeting

  8. Aims

  9. Aims

  10. Health Service Service Volume, Service Mix, Treatment Differences

  11. Number of Deliveries in Six months to December 2007 Maternity KPI Report, B1.01

  12. Percent of deliveries with previous Caesareans (Potential VBACs)

  13. Rate of vaginal births after caesareans

  14. Rate of Caesarean Deliveries Caesarean section rates range from 18% at Fury to 40% at Cougar3 Maternity KPI Report B3.01

  15. ALOS-Caesarean Deliveries (O01 Family) Varies from 6.3 days at Poseidon, to 3.3 at Titan Maternity KPI Report, B4.11

  16. Caesarean Deliveries-Casemix DRG O01C

  17. Relative Stay Index-All Caesarean Deliveries Ranged from 110% at Poseidon and Sirius3 to 75% at Titan, Fox, Hera2, Scorpio Maternity KPI Report, B4.11

  18. Caesarean Deliveries-Casemix DRG O01C

  19. Procedure Time Comparisons Elective lower segment procedure time ranges from 40 minutes at Cougar3 to 100 minutes at Wolf

  20. Caesarean Deliveries-Casemix DRG O01C Complications of Care Antrares4 and Gemma have >10% complication rate in their caesarean deliveries HRT Casemix Report; HRT_Drg51Data20072007V2

  21. Caesarean Deliveries-Casemix DRG O01C Emergency Readmits . Demeter, Scorpio2, and Lynx have a >3.5% Emergency Readmission Rate HRT Casemix Report; HRT_Drg51Data20072007V2

  22. Primary Caesareans

  23. Primary Caesareans Primary Caesareans represent 68% of the total caesarean rate at Electra. At Titan, it is 52.6% Maternity KPI 2008 Report B3.02

  24. Primary Caesareans 9.5% of all deliveries are primary caesareans at Fury, contrasted with nearly 24% at Cougar3 14.5% Maternity Benchmarking Group 2008 Report B1.01 B3.01/B3.02

  25. Primary Caesareans 8 hospitals use standard criteria when determining need for a primary Caesarean

  26. Emergency Primary Caesareans 82% of Primary Caesareans were emergency at Electra. Cougar3 and Dionysis both had ~65% Maternity Benchmarking Group 2008 Report B3.03

  27. Primary Caesarean and Fetal Distress At 5 hospitals (Antares2, Antares4, Apollo, Poseidon, Sirius4) >40% of women who had primary caesareans were also coded for fetal distress. Maternity Benchmarking Group 2008 Report B3.04

  28. Primary Caesareans and Failed Instrument Use Titan has a rate of emergency primary caesarean deliveries with failed instrument use ~15% Maternity Benchmarking Group 2008 Report B3.06

  29. Emergency Primary Caesareans and Induction of Labour At Scorpio2, 12.6% of women were induced and had an Emergency Primary Caesarean. Dionysis <1% Maternity Benchmarking Group 2008 Report B3.05

  30. Primary C-section rate definition

  31. Primary Caesarean at Full Dilation Altair has a rate of emergency primary caesarean deliveries at full dilation nearly 13 percentage points higher than Hera2, the next highest hospital Maternity Benchmarking Group 2008 Report B3.07

  32. Failure to Progress and Emergency Primary Caesareans – 82% at Altair Maternity Benchmarking Group 2008 Report B3.07

  33. Delivery CharacteristicsMother

  34. Percent of total births which are midwife-led Lynx and Fury had the highest rates of total births that are midwife-led Maternity Survey, 2.3

  35. Rate of Complications: Mother Antares4, has an overall rate of complications >15%; Lynx <1% Maternity KPI Report, B8.01

  36. Rate of Epidural Complications Rate of complications at Antares4 at 4%, more than double the next highest hospitals 4 hospitals at or near zero Maternity KPI Report, B6.12

  37. Rate of 3rd or 4th Degree Tears in Vaginal Deliveries Anteres2 has a rate of 3rd or 4th degree vaginal tears in 5.5% of vaginal deliveries Titan, Fox2, Cougar3 <1% Maternity KPI Report, B8.03

  38. Characteristics of the Neonate

  39. Low Birth Weight The rate of low birth weight recorded at Hera2 (37%) was almost double the rate at Gemma, the next highest hospital Maternity KPI Report B9.01

  40. Apgar Score The Percentage of babies delivered with a 5-min Apgar score less than 4 less than 1% in most hospitals Anteres4 and Poseidon >5%Full year as opposed to 6-month data? If so, ~3% rate Maternity KPI Report, B1.01, B9.03 Survey 2.1 (Note: if answer to survey question was given as percentage and data could not be generated, survey percentage is reported in the graph

  41. Rate of Perinatal Mortality in Hospital Rate of perinatal mortality is 0% at Lynx and Titan, >3% at Gemma, Hera2 Maternity KPI Report B9.03 Measure updated from previous survey-only includes >= 24 Weeks and Weight >= 500g)

  42. Survey ResultsDemographics

  43. Drug Addiction Ranged from 1.2% at Fox3 to approximately 10% at both Sirius3 and Lynx. 5 hospitals reported that they did not collect this information. Maternity Survey 1.1

  44. BMI>35 For those reporting, the answers ranged from approximately 4.5% at Altair to 13.5% at Antares4. 5 out of 8 hospitals reported a number greater than or equal to 10%. Maternity Survey Report 2008 1.2

  45. The rate averaged 21%, >27% (the average rate for Australian women in the 25-34yr age group) at Titan, Gemma, and Poseidon, (Cancer Council NSW) Smoking Maternity Survey Report 2008 1.3

  46. Breastfeeding on discharge The percentage of women breastfeeding exclusively at discharge >80% for 9 of 11 reporting hospitals. Maternity Survey Report 2008 1.16

  47. Other Indicators of Interest? Survey Document Casemix-Base Report

  48. Key Issues to address • Definitional issues for existing indicators? • Data quality issues? • Clinical practice issues? • Different indicators?

  49. Prioritising Good Ideas • Is it a real opportunity? • Evidence that it works elsewhere? • Is it worth the effort? • Sufficient volume? • Substantial improvement in risk/benefit or cost benefit? • Can we do it? • Someone to champion? • Willing staff? • Sufficient resources?

  50. Aim Goal statement for improving the process To reach whatgoal ________ By when __________ In what area ___________ To reduce total time in antenatal clinic to 30 minutes by Dec 2008 for follow-up patients

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