Maternity dashboard

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qÜÉ=j~íÉêåáíó=a~ëÜÄç~êÇ= South East Coast Maternity Dashboard: ACTIVITY = Surrey & Sussex Healthcare Between Feb-10 and Jan-11 1.2

700

1.2

Women booked before 12(+6) complete weeks

Women Delivered 600

0.6

Maintain spontaneous Vaginal Delivery rate

Maintain Normal delivery rate

Ventouse & Forceps

0.5

0.8

0.4

0.6

0.3

0.4

0.2

0.1

500

400

300

0.4

Oct-10

Nov-10

Sep-10

Jul-10

Aug-10

Jun-10

Apr-10

May-10

Mar-10

Feb-10

Jan-11

Dec-10

Oct-10

Nov-10

Sep-10

Jul-10

Aug-10

Jun-10

Apr-10

May-10

Mar-10

Feb-10

Jan-11

Dec-10

Oct-10

Nov-10

Sep-10

Jul-10

Aug-10

Jan-11

0.5

0.6

Dec-10

0.5

Jun-10

Apr-10

May-10

Mar-10

Feb-10

Jan-11

Dec-10

Oct-10

0.6

C- Section - Total rate (planned & unscheduled)

Jan-11

0.3

Nov-10

0.6

Induction of labour (not augmentation)

Failed Operative Vaginal Delivery

Dec-10

0.6

Sep-10

Jul-10

Aug-10

Jun-10

Apr-10

Feb-10

Jan-11

Dec-10

Oct-10

0.35

Nov-10

Sep-10

Jul-10

Aug-10

Jun-10

Apr-10

May-10

Mar-10

Feb-10

May-10

100

Mar-10

200

1.2

Emergency caesarean section

Elective caesarean section

Successful VBAC (opting women)

0.5

0.4

0.8

0.3

0.6

0.2

0.4

0.1

0.2

0.25

0.2

0.15

Nov-10

Oct-10

Sep-10

Jul-10

Aug-10

Jun-10

May-10

Apr-10

Mar-10

Feb-10

Jan-11

Oct-10

Dec-10

Nov-10

Sep-10

Jul-10

Jun-10

Aug-10

May-10

Apr-10

Mar-10

Feb-10

Jan-11

Dec-10

Nov-10

Oct-10

Aug-10

Sep-10

Jul-10

Jun-10

Apr-10

May-10

Mar-10

Feb-10

Jan-11

Dec-10

Nov-10

Oct-10

Sep-10

Jul-10

Aug-10

Jun-10

May-10

Apr-10

Mar-10

Feb-10

Jan-11

Dec-10

Nov-10

Oct-10

Sep-10

Jul-10

Jun-10

Aug-10

Apr-10

May-10

Jan-11

Dec-10

Nov-10

Oct-10

Sep-10

Jul-10

Aug-10

Jun-10

Apr-10

May-10

Mar-10

Feb-10

Mar-10

0.05

Feb-10

0.1

In conjunction with clinical colleagues, the South East Coast maternity dashboard has been designed to help front line staff in maternity services to monitor their performance on a wide range of key indicators across a variety of domains. Development of the measures, led by a Heads of Midwifery reference group, was grounded in evidence on best practice. In total there are over twenty measures that are reported by all trusts on a monthly basis. Taken together, the measures present a comprehensive picture of services against standards that have been agreed by midwifery staff across the region. This leaflet gives a brief overview of the key measures included in the dashboard and presents a view of the tool that has been designed to help staff utilise the information in a clear and accessible way. Turn over to find out more…...

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tÜ~íÛë=áå=íÜÉ=j~íÉêåáíó=Ç~ëÜÄç~êÇ\= Much of the information included in the maternity dashboard cannot be gleaned from central systems such as SUS, so a reporting process is in place that enables trusts to supply the Quality Observatory with their information, which is then analysed and returned to units. This is achieved through the use of a template which is completed and returned for each organisation; you can see how this is laid out below. Type

Section

Metric Name

Women Delivered

Benchmarked to 3300 per annum Women delivered (Locally agreed Locally agreed forecast forecast) pa, 420pm Women booked before 12(+6) complete weeks Bookings (1st visit)

Scheduled Bookings Spontaneous Vaginal Deliveries

Maintain spontaneous Vaginal Delivery rate

Measure

SVD Rate

Goal

Red Flag Comment

Data Source Maternity IT system/Compare with HES

Other notes/comments Mums/Babies - Inc home and BBA's (live and still)

≥330

<310 or>370

90%

<80%

If <85% review by HOM Maternity IT system

<60%

MLBU delivery numbers to be included

Maternity IT system

>15%

Review of failed instrumental deliveries

Maternity IT system

15% = Red, Amber or Green?

Maternity IT system

5% = Red, Amber or Green? / Risk Assess and Manage

>70%

Phased 09/10 - 85%; 10/11 - 90%

Normal Deliveries Activity Ventouse & Forceps

Instrumental del rate

<15%

Instr. Vag Del

Induction

LSCS

Failed Instrumental Delivery Induction of labour (not augmentation)

Total rate (planned & unscheduled)

Failed Instrumental del rate Induction rate

C/S rate overall

<5%

>5%

20% or less

>25%

Maternity IT system

>26%

Weekly review of emergency C/S and decision making Maternity IT system

23% or less

The maternity dashboard is grouped into four domains, each of which contain a number of indicators: • Organisation domain: ∗ Unit not accepting admissions ∗ Unit requires support from unit within same organisation ∗ In utero transfers outside of network • Activity domain: ∗ Number of women delivered ∗ Percentage of women booked before 12+6 weeks gestation ∗ Spontaneous vaginal delivery rate ∗ Normal delivery rate ∗ Instrumental delivery rate (ventouse & forceps) ∗ Failed operative vaginal delivery rate. ∗ Induction of labour rate ∗ Overall caesarean section rate, subdivided for elective and emergency rate ∗ Successful VBAC rates (opting women only) • Workforce domain: ∗ Weekly hours of dedicated consultant presence on labour wards (units >2,500 births per year only) ∗ Weekly hours of dedicated consultant presence on labour wards (units <2,500 births per year only) ∗ Woman/midwife ratio ∗ Midwifery workforce funded establishment as whole time equivalent ∗ Midwifery workforce actual establishment as whole time equivalent ∗ 1:1 care in labour • Clinical domain: ∗ Number of cases of meconium aspiration ∗ Number of term babies admitted to special care (unexpected) ∗ Number of intrapartum stillbirths ∗ Number of term neonatal deaths (< 7 days) ∗ Number of cases of hypoxic encephalopathy (Grades 2&3) ∗ Number of serious untoward incidents ∗ Massive post partum haemorrhage rate (>2 litres) ∗ Shoulder dystocia rate ∗ 3rd/4th degree tear rate ∗ Breastfeeding rate at initiation=

Whilst a completed data collection tool will give trusts all the required data, the number of indicators included means that it can be difficult to see an overall picture of a unit’s performance in each of the domains. In addition, one of the things that makes this kind of information even more useful is the ability for trusts to benchmark themselves against each other, something that would not be possible if trusts just utilised their own data. To achieve this, a method of collation and presentation of all this data was required, and in a format that made it easy to see how organisations were performing against their goals (and red flags!). This led to the development of the maternity dashboard, an interactive tool that enables examination of each domain in a graphical format with simple colour coding to indicate performance levels over time against the agreed goals and red flags. On the front page of this leaflet is the page for the activity domain; the figure below shows the clinical domain.

South East Coast Maternity Dashboard: CLINICAL INDICATORS Frimley Park Between Jan-10 and Dec-10

0.035

Dec-10

Oct-10

Nov-10

Sep-10

Jul-10

Aug-10

Jun-10

Apr-10

1.2

Shoulder dystocia

Massive PPH >2500mls

Cases of hypoxic encephalopathy (Grades 2&3)

Jan-10

Dec-10

Oct-10

Nov-10

Sep-10

Jul-10

Aug-10

Jun-10

Apr-10

May-10

Mar-10

Jan-10 0.07

0.045

Number of SUIs

Feb-10

Dec-10

Oct-10

Nov-10

Sep-10

Jul-10

Aug-10

Apr-10

Jun-10

Apr-10

May-10

Mar-10

Jan-10

Feb-10

Dec-10

Oct-10

Nov-10

Sep-10

Jul-10

Aug-10

Jun-10

Apr-10

May-10

Mar-10

Jan-10

Feb-10

Dec-10

Oct-10

Nov-10

Sep-10

Jul-10

Aug-10

Jun-10

May-10

Mar-10

Term neonatal deaths < 7 days

Jan-10

Feb-10

Intrapartum stillbirths

May-10

Number of term babies admitted to SCBU/NICU unexpected

Mar-10

Cases of meconium aspiration

Feb-10

Breastfeeding at Initiation

3rd/4th degree tear

0.04 0.03

0.06

0.035 0.025

0.05

0.8

0.03

0.02

0.04

0.025

0.6

6 0.02

0.015

0.03 0.4

0.015 0.01

0.02 0.01 0.2

0.005

0.01 0.005

Dec-10

Nov-10

Oct-10

Sep-10

Aug-10

Jul-10

Jun-10

May-10

Apr-10

Mar-10

Jan-10

Dec-10

Nov-10

Oct-10

Sep-10

Aug-10

Jul-10

Jun-10

Apr-10

May-10

Mar-10

Jan-10

Feb-10

Dec-10

Nov-10

Oct-10

Sep-10

Aug-10

Jul-10

Jun-10

May-10

Apr-10

Mar-10

Feb-10

Dec-10

Nov-10

Oct-10

Sep-10

Aug-10

Jul-10

Jun-10

May-10

Apr-10

Mar-10

Jan-10

Feb-10

Dec-10

Nov-10

Oct-10

Sep-10

Aug-10

Jul-10

Jun-10

May-10

Apr-10

Mar-10

Jan-10

Feb-10

Jan-10

The slide bar at the top right of the dashboard allows the user to change the time period that is displayed on the charts; this enables more than twelve months of data to be available in the tool, without over crowding the axes! As well as showing the indicators within the four domains, the dashboard includes a page of data completeness and quality, that helps to ensure the dashboard is as reliable a source of information as possible.

^åÇ=ãçêÉÁKK>= The maternity dashboard is part of a suite of tools that support the QIPP maternity and newborn workstream. A neonatal dashboard has also been developed that measures progress for all special and intensive care baby units against key improvement priorities. A subset of ten measures from the maternity dashboard are used to measure progress of the QIPP workstream at a high level. In depth regional innovation projects such as the Normalising Birth programme are also supported by the Quality Observatory; more information on the measurement tools developed and used in delivering this programme can see found in the Normalising Birth series of leaflets.

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