Cate Langley

1
A Survey to Identify Who, How and What Maternity
Data is Collected in Welsh Maternity Units

• Cate Langley
• Lead Midwife, North Powys.

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Accurate, reliable data.
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A Welsh Issue?

• Not everyone appears to be collecting the same
  information.
• Not all units appear to be collecting maternity
  tail data.
• There is confusion regarding some data
  definitions.
• There is a lack of clarity on where data goes
  once it leaves the midwives.
• There is a lack of clarity on what is being done
  with the data nationally and locally.
• There does not appear to be any information
  coming back to individual NHS trusts regarding
  the data collected nationally and minimal
  feedback from local data collection.
• There is no information on the data collection
  systems already in use across the Principality.

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• Aim of study

To identify what data are collected, where that
data are collected and by whom in maternity
services.
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• Objectives

• To identify whether the problem of data access
  and quality is a local issue to Welsh maternity
  services or whether a body of evidence exists
  that identifies this as a far wider heath care
  issue.
• To identify a means of collecting information on
  how and what data are collected within Wales.
• Once a means of collection was identified to
  include all maternity services in Wales in the
  collection process.
• To review findings and formulate recommendations
  for the future collection and analysis of data.

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• Process
• Literature review
• Design
• MREC
• RD Approval
• Analysis
• Response

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• Data collection systems in Wales

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Systems methods of collecting data
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Computerised data collection
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• Not everyone appears to be collecting the same
  information

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Maternal date of birth Maternal origin
Ethnicity (census definition) Ethnicity (local
definition) Maternal occupation Fathers
occupation Marital/Cohabitation status Maternal
height Medical history Previous blood
transfusion Maternal rubella status Gestation
at booking Gestation by LMP Assisted conception
AN booking appointment Ante natal visits Out
patient ANV Actual place of birth Reason for
change of place of birth Presentation Apgar
score at 1 minute Apgar scores at 5 minutes
Paediatric estimation of gestational age
Assessment of hips
Smoking history Smoking during pregnancy Parity
Previous births Previous stillbirths Previous
miscarriages Previous terminations of pregnancy
Previous caesarean section
Antenatal in patient admissions Antenatal tests
Ultrasound scans Antenatal administration of
steroids Method of onset of labour Date and
time of birth Method of delivery Length of 1st
stage Length of 2nd stage Length of third stage
Third stage management Perineal tears
Episiotomy Intended place of birth
Gestation at onset of labour (LMP) Gestation at
onset of labour (USS) Live or stillbirth
Multiple birth Birth order Pain relief Reason
for administration of pain relief Pain relief in
labour Pain relief delivery Pain relief post
natal Suturing of tears Maternal complications
Status of person conducting delivery Length of
postnatal stay Post natal outpatients Postnatal
community visits Sex of baby Birth weight Head
circumference Length
Jaundice Congenital abnormalities Admission to
Special care Baby Unit Neonatal resuscitation
Feeding at discharge Metabolic screening
Neonatal BCG Paediatric follow-up
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• Statistics

Smoking history
Multiple birth Smoking during pregnancy
Birth weight Onset of labour
Method of delivery Pain relief Perineal
tears Episiotomy Suturing of tears Live or
stillbirth
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Audit of data accuracy
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• Production of
  statistics

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Accessing missing data
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• All statistics are obtained manually from
  delivery book entry. Im sure information is
  sometimes missed out due to lack of space or
  error by midwife. The time it takes to collect
  this data means we are always at least 3-4 months
  behind.
• They are probably available from the system that
  we use but no one trained or has time to get them

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• Not all units appear to be collecting maternity
  tail data.

Wrong
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• There is confusion regarding some data
  definitions

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• There does not appear to be any information
  coming back to individual NHS trusts regarding
  the data collected nationally and minimal
  feedback from local data collection.
• There is a lack of clarity on where data goes
  once it leaves the midwives.

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• Sharing information
• Aggregated Patient specific
• GPs
  GPs
• LHBs
  Registrar of births
• Regional office
  Child Health
• PEDW
• WAG
• Need to know
• CEMACH, CARIS

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?
WOMEN

MATERNITY COMPUTER
Maternity notes
HOSPITAL
COMMUNITY TEAM



Registrar of births
Paper record
OUTSIDE AGENCIES PEDW, WAG
Data Flow

Computer record

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• Care outside of Hospital

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• Time

?
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• Past and present strategies

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• Study limitations

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• How are data collected?
• A mixture of computer and paper
• What data are collected?
• Large amounts
• Who collects data?
• Predominately midwives

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• Recommendations

• That agreement is made regarding the data items
  that need to be collected across Wales, to
  include agreement on data definitions.
• National data bases, that presently hold
  maternity information, be reviewed for their
  ability to provide the information clinicians,
  users, trusts and government require.
• That any future databases reflect the care given
  in community settings as well as hospital.
• That no new data collection process is introduced
  without proper analysis of the costs and benefits
  to clinicians, users, trusts and government.

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• Recommendations

• That databases, whether local or national are
  able to provide information to users on local
  services, trusts on their activity and how they
  compare to others and individual clinicians on
  the outcomes of the care they give.
• That any strategies for maternity services also
  identify the data collection requirements
  necessary to prove success and ensure these are
  identified and collectable prior to
  implementation.
• That trusts are encouraged to make accurate,
  reliable data a priority for maternity services
  by identifying an individual(s) within the trust
  to be responsible for the coordination of data
  collection, reliability and completeness.