a survey to identify who, how and what maternity data are collected in welsh maternity units

Cate Langley MScLead Midwife, North Powys.

A Survey to identify who, how and what maternity data are collected in

Welsh Maternity Units

Accurate, reliable data.

• Not everyone appears to be collecting the same information.• Not all units appear to be collecting ‘maternity tail’ data.• There is confusion regarding some data definitions.• There is a lack of clarity on where data goes once it leaves

the midwives.• There is a lack of clarity on what is being done with the data

nationally and locally.• There does not appear to be any information coming back to

individual NHS trusts regarding the data collected nationally and minimal feedback from local data collection.

• There is no information on the data collection systems already in use across the Principality.

A Welsh Issue?

Aim of study

To identify what data are collected, where that data are collected

and by whom in maternity services.

Objectives•To identify whether the problem of data access and quality is a local issue to Welsh maternity services or whether a body of evidence exists that identifies this as a far wider heath care issue. •To identify a means of collecting information on how and what data are collected within Wales.•Once a means of collection is identified to include all maternity services in Wales in the collection process. •To review findings and formulate recommendations for the future collection and analysis of data.

Process

• Literature review

• Design

• MREC

• R&D Approval

• Analysis

• Response

Data collection systems in Wales

Systems & methods of collecting data

1

5

1

5

1

2

2

1

Midw ives directly onto computer

Paper and computer by midw ives

Paper by midw ives and onto computerby clerical staff

Paper only midw ives

Birth notif ication only on computer, allother by midw ives on paper

Directly by midw ives onto computerand paper then computer by midw ives

Directly by midw ives onto computer,paper then computer, midw ives paperonto computer by clerical staff

All of the above

Computerised data collection

4

7

2

11

Protos

PAS

In house

Other system

SMMIS

Not everyone appears to be collecting the same information

Maternal date of birth

Maternal origin

Ethnicity (census definition)

Ethnicity (local definition)

Maternal occupation

Father’s occupation

Marital/Cohabitation status

Maternal height

Medical history

Previous blood transfusion

Maternal rubella status

Gestation at booking

Gestation by LMP

Assisted conception

AN booking appointment

Ante natal visits

Out patient ANV

Actual place of birth

Reason for change of place of birth

Presentation

Apgar score at 1 minute

Apgar scores at 5 minutes

Paediatric estimation of gestational age

Assessment of hips

Smoking history Smoking during pregnancy Parity Previous births Previous stillbirths Previous miscarriages Previous terminations of pregnancy Previous caesarean section

Antenatal in patient admissions Antenatal tests Ultrasound scansAntenatal administration of steroids Method of onset of labour Date and time of birth Method of delivery Length of 1st stage Length of 2nd stage Length of third stage Third stage management Perineal tears Episiotomy Intended place of birth

Gestation at onset of labour (LMP) Gestation at onset of labour (USS) Live or stillbirth Multiple birth Birth order Pain relief Reason for administration of pain relief Pain relief in labour Pain relief delivery Pain relief post natal Suturing of tearsMaternal complications Status of person conducting delivery Length of postnatal stay Post natal outpatients Postnatal community visits Sex of baby Birth weight Head circumference Length

Jaundice Congenital abnormalities Admission to Special care Baby Unit Neonatal resuscitation Feeding at discharge Metabolic screening Neonatal BCG Paediatric follow-up

Statistics

Smoking history Multiple birth

Smoking during pregnancy Birth weight

Onset of labour Method of delivery

Pain relief

Perineal tears

Episiotomy

Suturing of tears

Live or stillbirth

Audit of data accuracy

2

4

1

5

6 w eekly

monthly

annual

not audited

don't know

Production of statistics

6

1

6

4

1Statisticalprogramme inmaternity systemSeparate softw are

on paper

on paper andcomputer

paper and othersoftw are

4

22

4<1hour

1 w orking day

month

Don't know

Accessing missing data

“All statistics are obtained manually from delivery book entry. I’m sure information is sometimes missed out due to lack of space or error by midwife. The time it takes to collect this data means we are always at least 3-4 months behind.”

“They are probably available from the system that we use but no one trained or has time to get them”

Not all units appear to be collecting ‘maternity tail’ data.

There does not appear to be any information coming back to individual

NHS trusts regarding the data collected nationally and minimal

feedback from local data collection.

There is a lack of clarity on where data goes once it leaves the midwives.

HOSPITALCOMMUNITY

TEAM

Registrar of births

OUTSIDE AGENCIES

PEDW, WAG

MATERNITY COMPUTER

WOMEN

Paper record

Computer record

Data Flow

?

Maternity notes

There is confusion regarding some data definitions

Sharing informationAggregated Patient specificGPs GPs

LHBs Registrar of births

Regional office Child Health

PEDW

WAG

Need to knowCEMACH, CARIS

Care outside of Hospital

Time

Past and present strategies

Study limitations

How are data collected?

A mixture of computer and paper

What data are collected?

Large amounts

Who collects data?

Predominately midwives

Recommendations

•That agreement is made regarding the data items that need to be collected across Wales, to include agreement on data definitions.

•National data bases, that presently hold maternity information, be reviewed for their ability to provide the information clinicians, users, trusts and government require.

•That any future databases reflect the care given in community settings as well as hospital.

•That no new data collection process is introduced without proper analysis of the costs and benefits to clinicians, users, trusts and government.

Recommendations•That databases, whether local or national are able to provide information to users on local services, trusts on their activity and how they compare to others and individual clinicians on the outcomes of the care they give.

•That any strategies for maternity services also identify the data collection requirements necessary to prove success and ensure these are identified and collectable prior to implementation.

•That trusts are encouraged to make accurate, reliable data a priority for maternity services by identifying an individual(s) within the trust to be responsible for the coordination of data collection, reliability and completeness.

• Accuracy of data collected.• Accessibility of data collected and its

analysis.• Completeness.• Non-standard terminology.• Amounts of data collected versus amounts

used.

(Audit Commission, 1995a,1995b, 2002; House of Commons Health

Committee, 2003; WAG, 2002a

There is a lack of clarity on what is being done with data nationally and

locally

Training