Maternity units record 660 clinical incidents in December

More than 660 clinical incidents were reported in Irish maternity units last December, according to the first published statements detailing their performance.

There were 13 baby deaths and eight “major obstetric events” across the 19 maternity units, according to the safety statements published by the HSE.

Rates of Caesarean section varied hugely between different units, from 21.3 per cent in Waterford University Hospital to 40.3 per cent in the country’s smallest unit, South Tipperary Hospital in Clonmel.

The statements, which are designed to help intending mothers make informed choices about local maternity services, are being published despite some misgivings within obstetrics.

When the three Dublin maternity hospitals published their figures last week, they did not include data on clinical incidents.

Since The Irish Times reported on their statements, this information has been added, bringing the format of their statements into conformity with those from the other 16, HSE-run units.

The masters of the Dublin maternity hospitals argued, in correspondence with the HSE last year, that publication of the data would leave hospitals open to adverse publicity and media scrutiny, pose risks to patient confidentiality and encourage inappropriate comparisons between maternity units of varying size and complexity. Rates of stillbirth and neonatal deaths are higher in tertiary referral centres, which receive cases of congenital anomaly, prematurity and other complications from other units, they pointed out.

The newly-published statements for December 2015 show a wide variation in the number of clinical incidents, from zero reported by Portiuncula Hospital in Ballinasloe to 158 at the - far larger - National Maternity Hospital. The Coombe hospital reported 86 clinical incidents, Cork University Hospital 72 and the Rotunda Hospital 67.

A clinical incident is defined as an event or circumstance that could have resulted, or did result, in unnecessary harm to a patient.

The number of births varied from 77 in Clonmel to 780 in the NMH.

The safety statements provide information on 17 different metrics, including the number of babies delivered and the number of transfers to or from a hospital.

The statements do not include information on the number of maternal deaths, or the rate of perinatal death for babies born without a congenital anomaly.

The HSE said the metrics chosen were included because they were “clinically robust, relevant and underpinned by standardised definitions”. Additional metrics would be added to the statement in the future.

"The publication of this data should provide welcome reassurance for women using our services," said HSE clinical lead in obstetrics, Prof Michael Turner. He said the data should be interpreted "with caution" where low numbers were involved.

There were three major obstetric events - eclampsia, uterine rupture, peripartum hysterectomy or pulmonary embolism - in the Rotunda and Cork and two in Limerick maternity hospital.

“Given the complexity of care at our hospital, which is a national tertiary referral centre, it is not appropriate to compare any of these statistics with other hospitals that have different patient numbers or types of clinical workload,” the preface to each hospital statement says. There are also variations between the patient profile of the three Dublin hospitals.

Publication of the information, which has been championed by the Department of Health's chief medical officer, Dr Tony Holohan, was promised in reports published in the wake of the controversy over baby deaths at Portlaoise hospital.

The HSE says the safety statements for each maternity unit will be published monthly from now on.