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