NPEC The Potential Value to our Patients and

NPEC - The Potential Value to our Patients and Specialty Richard A Greene Director The National Perinatal Epidemiology Centre

Cork University Maternity Hospital

Cork University Maternity Hospital

Cork University Maternity Hospital

Outline of Talk • Background • Legislative Demands for Audit • The Lourdes Hospital Enquiry • The National Perinatal Epidemiology Centre

A Future Research Centre?

The BUPA Research Centre Incorporating: • Centre for Molecular Human Reproduction • Centre for Innovation in Gynaecological Surgery • National Perinatal Centre

The BUPA Research Centre

Department of Obstetrics and Gynaecology Development of a National Perinatal Centre (as part of the BUPA Ireland Research Centre) April 2004

Background • Dublin Hospital Reports • Dr Dermott Mc. Donald • International Exposure to data collection • The Lourdes Hospital Inquiry

Minister’s Statement March 2006 • "Cork is an ideal location because of the recent completion of the Cork University Maternity Hospital and the development of a research centre focused on women's health and reproduction. • In addition, the National Cancer Registry, the Central Statistics Office and the Health Information and Quality Authority are all located in Cork. "

The BUPA Research Centre High Level Advisory Committee: Chief Medical Officer (DOHC) International Expert in Perinatal Epidemiology Professor James King (PDCC Victoria) Chairman of the Institute of Obstetrics Research Scientist Business Representative

The National Perinatal Epidemiology Centre ‘Greater than the thread of mighty armies is an idea whose time has come’ Victor Hugo

Clinical Audit A process that seeks to improve patient care and outcomes - through systematic review of care - against explicit criteria - the implementation of change - further monitoring to confirm improvement

Clinical Audit Assesses the quality of everyday care provided to patients with common conditions Our society must be assured that mothers and babies are receiving services of the highest standards

Clinical Audit • Depends on enthusiasm and commitment to high quality patient care Fact/Fiction: Enthusiasm and commitment to high quality patient care is the norm in Irish Maternity services!

Dublin Maternity Hospital Reports

Legislative Background Do we really have to undertake audit ?

General Medical Council, UK Doctors – ‘must take part in regular and systematic medical and clinical audit, reporting data honestly. Where necessary you must respond to the results of audit to improve your practice, for example by undertaking further training’ (GMC, 2001)

‘Learning from Bristol: the report of the public enquiry into Children’s Heart Surgery at the Bristol Royal Infirmary 1984 -1995’ Clinical Audit should be compulsory for all healthcare professionals providing clinical care and the requirement to participate in it should be included as part of the contract of employment

• Doctors enrolled in the CQA programme will be asked to include evidence of participation in peer review processes and clinical audit in their CQA portfolios • Clinical audit is recognised as a quality improvement tool, especially if part of a national audit system.

Medical Practioners Bill, 2007 ‘An obligation on the Health Services Executive and other employers to facilitate the maintenance of professional competence of medical practioners (clinical audit, continuing medical education and peer review)’

UK Central Council for Nurses, Midwives and Health Visitors, 2001 ‘…clinical governance, assisting the coordination of quality improvement initiatives such as clinical audit, is ‘the business of every registered Practioner’

An Bord Altranais • To provide evidence that may be required for the purposes of Clinical audit

Lourdes Hospital Inquiry • Background • Reports made but no facility to assess • No surveillance method

The Lourdes Hospital Inquiry Requirements for Audit: • ‘The lead clinician…. responsible for organising regular clinical audit’ • ‘It is recommended that the duty to ensure that regular and effective audit takes place is delegated to a specific consultant’

The Lourdes Hospital Inquiry National Monitoring/Surveillance: • ‘Consideration to reporting sentinel events into a national integrated monitoring system. ’ • ‘This system will be in addition to but separate from clinical incident reporting. ’

The Lourdes Hospital Inquiry Annual Clinical Reports: • ‘Annual clinical reports of activity and outcomes should be prepared and published within 9 months of the previous year’s end. ’

The National Perinatal Epidemiology Centre Formal Agreement DOHC/HSE and UCC

NPEC Staffing • • Director (Obstetrician) Epidemiologist Senior Administrator/Report writer Database manager Data administrators (2) Research midwives (2) PA/secretarial support

NPEC - Objective • To translate epidemiological data and evidence-based best practice into improved clinical services for women and babies in Ireland.

NPEC Functions Core Function – – The collection, collation and analysis of outcome data from maternity hospitals in Ireland – Develop recommendations based on clinical audit – Perinatal epidemiology monitoring service – Expert committees – maternal morbidity and mortality Research - Clinical trials to assess new protocols, care methods, treatments

Perinatal Epidemiology • Current situation: – No nationally agreed dataset (or definitions) – Most units have no electronic system • Initial Functions of the NPEC – Develop dataset and definitions – Establish a uniform national chart – Assist development of an electronic patient record

National Dataset and Obstetric Chart • Representatives from clinical, academic and support units • Ensure acceptable dataset • Agreed definitions • Value added of dataset towards research • Subcommittee to develop an agreed obstetric chart

Expert Committees • Establish expert subcommittees to review and sign-off specific reports • NPEC undertakes data collection on maternal and perinatal morbidity and mortality • Manages functions of the committees • Further subcommittees in future • Permanent or task specific

Electronic Data Collection • Electronic Obstetric Record – Enhances completeness of data – Ensures more robust data • Opportunity to develop electronic reporting of trial/study data linked to electronic record

The Lourdes Hospital Inquiry ‘If every maternity unit was obliged each day to fill in key details of mother and baby into a computer programme with connections to the other maternity units in the State, and the data thus received was regularly analysed, there would be much benefit to the health system’.

Maximise the NPEC Potential • Inculcate the lessons from other centres • Build the national consensus for the centre • Embrace collaboration to enhance the skills and potential of the centre for all our patients

Collaboration • National Links – – Perinatal Ireland Collaboration with other Research Groups Clinical Indemnity Scheme Schools of Public Health • International Links – Victorian Perinatal Data Collection Unit – Perinatal Trials Unit Oxford – Global Network for Perinatal and Reproductive Health (GNPRH)

Ambition for the NPEC • To provide a complete record for a large dataset on every birth in Ireland allowing: – Thorough audit and monitoring of practice – Improved perinatal care and outcomes – Strengthening of trust between patient and care giver – A robust epidemiological service to assist research in developing and answering questions and testing new ‘treatments’

NPEC Should Provide • Comprehensive reports on all births in Ireland • Individualized Hospital reports • Specific interest reports

NPEC should provide • Benchmarking of outcomes for each unit – providing objective targets towards improved care • Robust data to assist units needing resources to improve outcome, develop services, etc • Personalized audit of outcome for Obstetricians (CQA)

Research: Molecule to Man to Metropolis

Summary • Evidence that the highest standards are being achieved/sought for mothers and babies • Improved perinatal care and outcome • Strenghtening of trust between care and caregiver • Evidence of involvement in national audit of practice for Obstetricians • Potential to support research in our specialty and keep Irish maternity services at the forefront in provision of best care

Patients and outcomes ‘Things which matter most must never be at the mercy of things which matter least. ’ Goethe

Patients - Our Focus!