Results of Maternity Safety Statements for 2016
One in eight mothers who gave birth in a maternity
hospital last year experienced what is classified by the HSE as a clinical
incident.
Figures published by the HSE reveal more than 7,200
clinical incidents were recorded during 2016 to mothers in labour.
A clinical incident is regarded as an event which
could have resulted, or did result, in unnecessary harm to a patient.
A total of 7,247 clinical incidents were recorded last
year involving approximately 12.6% of all women who gave birth in maternity
hospitals.
The highest rate was recorded in the National
Maternity Hospital in Holles Street where a clinical incident was recorded with
more than 1 in 4 mothers, while the lowest rate was in Letterkenny University
Hospital at just under 5%.
The figures are based on maternity safety statements
now published on a monthly basis by all of the country’s 19 maternity
hospitals.
Full data for 2016 has been made available by 16
hospitals while 10 and 11-month figures have been published respectively by
Wexford Hospital and University Maternity Hospital, Limerick.
The Rotunda in Dublin has refused to publish the
number of clinical incidents recorded among the 8,400 women who gave birth in
the hospital last year.
A spokeswoman for the Rotunda said the hospital did
not believe the number of clinical incidents recorded in the hospital was “any
indicator of safety.”
“Additionally, there is currently no agreement amongst
hospitals nationally as to which events require filing a clinical incident
report,” she added.
The Rotunda claimed its reports were “maternity
activity statements and not a patient safety report.”
The masters of Dublin’s main maternity hospitals – the
three largest in the country – voiced strong objections in 2015 to the HSE’s
decision to require hospitals to publish such information.
The heads of the National Maternity Hospital in Holles
Street, the Coombe and the Rotunda claimed the monthly statements would leave
hospitals at risk of “adverse publicity and media scrutiny.”
They were also concerned that their hospitals as
tertiary-referral centres would have higher rates of stillbirth, perinatal
deaths as they received more complex cases involving babies with higher rates
of congenital anomaly, prematurity and other complications.
The obstetricians also warned that a knock-on effect
of such scrutiny could be the under-reporting of some negative outcomes.
The HSE said the decision to publish such information was
taken to provide public assurance that maternity services are delivered in “an
environment that promotes open disclosure.”
“It is intended that reporting in an honest and open
way helps build trust and improves clinical performance and the culture of
safety,” the HSE said. “It is intended they will act as an early warning
mechanism for issues that require local action or any issues that need
intervention at hospital group or national level.”
However, it also stressed that the data should be
interpreted with caution as rates of clinical activity and outcomes will be
higher between larger and smaller maternity hospitals and units.
Publication of such statements was recommended in two
reports published separately by the HSE in 2014 and the Health Information and
Quality Authority in 2015 into the high rate of perinatal deaths at the Midland
Regional Hospital in Portlaoise between 2006 and 2014.
A total of 17 different pieces of data are collected
which the HSE claims are clinically robust, relevant and underpinned by
standardised definitions.
The 2016 figures show the Rotunda had the highest
perinatal mortality rate at 4.7 deaths per 1,000 births last year followed by
University Hospital Kerry in Tralee at 4.25 deaths per 1,000 births and St
Luke’s in Kilkenny at 3.08.
The highest rate of major obstetric events – which records
rare but potentially life-threating conditions such as eclampsia, uterine
rupture, peripartum hysterectomy and pulmonary embolism – was found in
University Maternity Hospital Limerick with 2.7 out of 1,000 mothers
experiencing such an event.
The percentages of mothers who were induced and given
Caesarean sections continued their recent upward trend again last year.
The highest rate of induction was in Our Lady in
Lourdes Hospital in Drogheda at 39.3% of all mothers compared to the national
average of around 32%. The lowest rate was in St Luke’s in Kilkenny at just
over 17%.
Almost one in three women who gave birth last year
delivered by Caesarean section with the highest rate of 40% recorded in St
Luke’s in Kilkenny. The lowest rate was 24.6% in University Hospital Waterford.
The national average was 32.5% up from 30.9% in 2015.
A report by the Economic and Social Research Institute
last October claimed the rising proportion of women having their babies delivered
by Caesarean section was placing an increased risk on their health. It noted
the share of babies delivered by C-section had more than quadrupled over the
past 30 years.
