Dublin maternity hospitals publish safety reports for first time

The three Dublin maternity hospitals have published monthly statements detailing safety and performance information for the first time.

The statements, designed to help intending mothers make informed choices about local maternity services, are being published despite the misgivings of the masters of the three hospitals.

Publication of the data would leave the hospitals open to adverse publicity and media scrutiny, pose risks to patient confidentiality, and encourage inappropriate comparisons between maternity units of varying sizes and complexities, the masters warned the HSE last year.

Rates of stillbirth and neonatal deaths will be higher in tertiary referral centres, which receive cases of congenital anomaly, prematurity and other complications from other units, they argued.

The safety statements provide information on the death rate for babies and the rate of “major obstetric events”, as well as the Caesarean section rate in each hospital.

They also provide more general information, such as the number of babies delivered and the number of transfers to or from a hospital.

Publication of the information, which has been championed by Department of Health chief medical officer Dr Tony Holohan, was promised in reports published in the wake of the controversy over baby deaths at Portlaoise hospital.

Metrics

The statements do not include information on the number of maternal deaths, or the rate of perinatal death for babies born without a congenital anomaly.

The HSE recommends that maternity units collect data on 33 metrics – the list published by the National Maternity, Rotunda and Coombe hospitals give information on 16 metrics.

The HSE said the metrics chosen were included because they were “clinically robust, relevant and underpinned by standardised definitions”. Additional metrics would be added to the statement in the future.

The first statements, for December 2015, show three babies died in the Rotunda out of a total of 734 births.

One died in the Coombe from a total of 702 births, while perinatal mortality in the National Maternity Hospital was zero, from 780 births.

There were two major obstetric events – a category that includes eclampsia, uterine rupture, peripartum hysterectomy and pulmonary embolism – in the Rotunda, one in the NMH and none in the Coombe during the month.

Complexity of care

“Given the complexity of care at our hospital, which is a national tertiary referral centre, it is not appropriate to compare any of these statistics with other hospitals that have different patient numbers or types of clinical workload,” the preface to each hospital statement says.

There are also variations between the patient profiles of the three Dublin hospitals.

The HSE says the safety statements for the remaining 16 maternity units in the State will be published by the end of February, and monthly thereafter.