The report presents a series of indicators that can be used to compare the performance of English maternity units. It is the first of what will be an annual account by the RCOG of variation in care delivered to women during childbirth.
This project, carried out in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM), uses Hospital Episode Statistics (HES) data from 2011/12 that is routinely submitted by each NHS hospital. For the first time, this data has been analysed in a way that enables fairer comparisons to be made between hospitals. The researchers have controlled for factors that increase the risk of a poor pregnancy outcome, but which are beyond the control of the hospital, such as the medical history of the mother.
The indicators reveal considerable variation among maternity units in England. For example, among women giving birth for the first time, there was a two-fold difference between hospitals with the highest and lowest rates of induction of labour (17% compared to 38%), emergency caesarean section after induction of labour (20% to 40%) and instrumental delivery (16% to 32%).
This variation is a source of concern as it could suggest that not all women are getting the best possible care, or that NHS resources are not being used in the most efficient way.
However, the report’s authors caution against over-interpreting the findings. Some of the observed variation could be due to differences in the quality of the data submitted by hospitals, and differences in patient characteristics that were not possible to control for.
The report includes eleven indicators including emergency maternal readmission within 30 days of delivery, third and fourth degree perineal tear rate amongst unassisted and assisted vaginal delivery and elective caesarean section rate.
The report makes a number of recommendations. It calls for units to use the indicators as a basis for reflection upon current practice and recommends that units should audit themselves against existing clinical guidelines to help identify causes of variation at a local level. It also highlights the need for clinicians to take ownership of their own data in order to drive up data quality.
Dr David Richmond, RCOG Vice President (Clinical Quality) said:
“This work represents a first step towards the development of a balanced suite of indicators that could be used by maternity services to monitor local obstetric care and improve quality of care.
“The initial set of indicators suggests wide variation in both practice and outcomes between maternity units which is a source of concern for the specialty as we cannot be sure that every woman is getting the best possible care.
“It highlights that specialist-delivered care must expand so that for women with complex obstetric needs – which may only become apparent during labour – care can be provided by trained clinicians 24 hours a day and 7 days a week.
“There is a need to improve the completeness and consistency of routine maternity data and we hope that this report will act as a stimulus for clinicians and units to improve their data collection activity which will ultimately lead to improving the quality of patient care.”
Following this first report, the RCOG aims to produce an annual report covering the whole of the UK, and to expand this suite of indicators to encompass other dimensions of maternity care, including neonatal outcomes and patient experience.
The full report can be found here.
For more information please contact Naomi Weston on 020 7772 6357