birmingham women’s hospital
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Birmingham Women’s Hospital. 37 th 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 - PowerPoint PPT PresentationTRANSCRIPT
Birmingham Women’s Hospital
37th Annual Clinical Report
April 2009 – March 2010Simon 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 long-standing 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
SMH07/08
BWH07/08
SMH08/09
BWH08/09
SMH09/10
BWH09/10
Hospital 5,050 7,251 5,226 7,183 5,529 5,907
Birth Suite 510 621 571 1,184
Home 209 94 209 105 192 80
Maternity DAU
Other
Unknown
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
SMH – BWH: mode of delivery
% SMH07/08
BWH07/08
SMH08/09
BWH08/09
SMH09/10
BWH09/10
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
Multiple births
Twins 108 125 132 140
Triplets 2 3 2 2
SMH – BWH: Gynaecology
SMH07/08
BWH07/08
SMH08/09
BWH08/09
SMH09/10
BWH09/10
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
• BCRM IVF/ICSI egg collections 1009
• BWH ACU treatment cycles 900
Scope of the report
• 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• 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• midwife sonographers• dating & growth scans• CoGs study• improved identification of growth restriction
• Resources?
Gynaecology (1)• 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 0-
3%• Apparently significant reduction in cases of ovarian
hyperstimulation
Gynaecology (3)
• Outpatient gynaecology• Not “just” ambulatory hysteroscopy, but includes:
• 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
• More focussed research strategy?
• Recruitment to major trials?
• Recruitment to specialities
• Maternal morbidity
• Neonatal morbidity
• IUGR?
• Gynaecological follow up
Challenges
• Complaints environment
• First trimester screening implementation
• NHSLA/CNST standards
• Financial environment
• Reorganisation of NHS – GP commissioning
Annual Clinical Report 2009-10
• Extremely busy unit
• High levels of clinical activity in all areas
• Achieving most externally set standards
• Innovative
• Thriving research environment