5 days ago
IPA says incomplete maternity hospital patient safety reports 'sloppy'
A review of monthly patient safety reports from the country's 19 public maternity units, has uncovered some significant gaps in the reporting of key information by hospitals.
The report says that missing information in some of the monthly Maternity Patient Safety Statements (MPSS) reports published by the hospitals involved in the process makes it difficult to form a fair and complete overview of national maternity care.
The 13-page review covers 2024 and was conducted by the Irish Patients' Association (IPA), and was submitted to the Health Service Executive.
Last week, a review team which examined issues at Portiuncula University Hospital in Galway, recommended that the Government order reviews into other maternity units, to see if similar issues arise.
The new IPA review says that if a hospital leaves the "clinical incidents" field blank, the HSE national leadership cannot readily tell from the published data whether that hospital has zero incidents, or simply failed to report.
It said that similarly, without year-to date totals from some of the largest maternity hospitals, it is impossible to quickly aggregate total births, or key events rates for the country.
Several hospitals left certain fields blank, for example not listing "In Utero Transfers" where the mother is transferred to a specialised neonatal facility, prior to birth.
IPA Director Stephen McMahon described the incomplete reports as sloppy and a major concern.
The Chief Executive of the Association for Improvements in Maternity Services (AIMS) said there was a lack of transparency, audit, comparability and timeliness with the reports.
Krysia Lynch said that the maternity safety statements were a great initiative, to give the public a month on month view of what is going on in the maternity services.
But she said it is quite difficult to access some of the statements and some are very out of date and the data is not complete.
In the IPA review, it found that several maternity hospitals omitted cumulative year to date figures, which the IPA said impairs the ability to see annual trends.
Some hospitals did not report total clinical incidents.
There were over 54,000 births in the year under review.
These monthly maternity review reports were part of a set of recommendations in 2014, by then Chief Medical Officer Dr Tony Holohan to ensure early detection of safety issues and to boost accountability. The reports began in 2016.
It followed a January 2014 RTÉ Investigations Unit documentary 'Fatal Failures' into the deaths of four babies at the Midland Regional Hospital in Portlaoise.
In response to the IPA review, the HSE said that it monitors and reviews maternity care at local, regional and national level and that the Maternity Safety Statements are just one of several published methods it uses to provide transparency to the public about maternity services.
The HSE acknowledged there remain "gaps in the completeness" of the maternity safety statements and that it has been following up with services to improve the quality of the maternity reports.
Towards the end of this year, the HSE said it plans to publish more comprehensive and timely information on maternity care, via the Irish Maternity Indicator System (IMIS) and all of the 19 hospitals will be identified, unlike with previous reports.
The Irish Patients' Association said that with more consistent and complete data reporting, and perhaps some future enhancements to metrics, the system can further ensure that mothers and babies nationwide receive the safest care possible "under a watchful, accountable system."
Currently, hospitals are asked to report 17 metrics under the MPSS.
The IPA said that other data should be added including unexpected transfer of babies to intensive care unit including to other hospitals; lack of oxygen to baby during birth cases and staffing levels/midwife to birth ratio plus patient feedback data.
The review has also suggested the collection and publication of other data: postpartum haemorrhage which is a leading case of maternal morbidity, episiotomy rate (surgical cut to assist delivery), vaginal birth after previous Caesarean section which indicates women being given the opportunity for a normal birth after a prior C-section.
The HSE said that the Maternity Patient Safety Statement (MSS) is only one of a number of data sets used in maternity care, and that the Irish Maternity Indicator System dataset is used more routinely from a clinical and corporate governance perspective.
In its reply to the IPA report, the HSE said the Dublin maternity hospitals not including year to date data figures in their MPSS returns, relates to the fact that they produce very detailed annual reports.
The HSE said the Dublin maternity hospitals cross validate all their data before the annual report is published and the validation could contradict the data in the MPSS, if changes have been made subsequent to MPSS publication.
The HSE said that there are some missing fields in the MSS reports as well as inconsistent use of zero values.
"Obviously the MSS should have been developed with mandatory fields, and only numeric values accepted. We will follow up with the maternity networks to focus on the accuracy of their data," the letter reply of April 22 last to the IPA from Killian McGrane, Director National Women and Infants Health Programme states.
The HSE said that during this year, the HSE will be making further changes to maternity data and it hopes to have enhanced maternity metrics in the public domain on a quarterly basis.
The HSE also said that the Irish Maternity Indicator System National Reports contain comprehensive data.
Currently that IMIS data is anonymised so that individual hospitals are not identified, however the HSE indicated this is due to change during this year.
