1. Prepared by Ruth Clark Maternity Services Data Manager Central Coast LHD May 2012 Using WHAs Benchmarking Data Revealing the results of the 09/10 WHA Maternity Care Report to clinicians at Gosford Maternity Service

2. Clinical Indicator Collection Internal Service Rate Based & Outcomes Indicators NSW Perinatal Data collection ACHS Obstetric Indicators WHA Clinical Benchmarking Indicators

3. Clinical Indicator Ownership Understand the system we work in Compare our service with external measures Recognise and celebrate excellence Determine where to undertake detailed analysis Examine the underlying causes for undesired outcomes Design changes to improve the system

4. Clinical Indicator Ownership – confidence in benchmarking Assist all levels of staff to understand value of benchmarking Make CIs easy to interpret. Present local CIs regularly and compare often Encourage discussion and disagreement

5. Promoting confidence in WHA benchmarks Forceps births

8. Promoting confidence in WHA benchmarks Caesarean Section

11. Promoting confidence in WHA benchmarks Blood Transfusion

14. Promoting confidence in WHA benchmarks Induction of Labour

17. Local Review of the 09/10 WHA Benchmarking Maternity Care Report

18. Doing Well NBAC successful trial of labour VB and PPH C/S and PPH Blood transfusion Stable Liveborn babies gest <32 weeks Liveborn term babies HIE grade 2 or 3 Improving C/S rate all women Selected primips vaginal births NBAC vaginal birth Elective repeat C/S 3rd & 4th degree tears Review of 09/10 WHA Benchmarking Maternity Care

19. Flagged for Immediate Attention C/S and General Anaesthetic Vaginal birth and epidural Selected primips induced Selected primips having spontaneous labour and unassisted birth Liveborn term babies with apgar 6 or less at 5 minutes

20. Flagged C/S and GA

21. Flagged Selected primips induced Selected primips and normal birth Preliminary audit findings 29% for gest >=41 weeks 27% for Prelabour ROM 6% diabetes <2% social Early recommendations Review home management of ROM program SS review of birth plans in diabetes clinic

22. Flagged Vaginal birth and epidural Audit findings Maternal request Rates lower in MMOC Recommendations Increase staffing of MMOC to care for more women Increase 1:1 midwife care in labour

23. Thank you