Data collection, timely analysis and reporting back to the health sector in a transparent manner is fundamental to improving quality and safety and to identify system failures when it occurs. One such system failure happened at the time of avoidable fetal deaths at a regional health service in Australia, that was picked up 2 years later – lack in data transparency being identified as one of the factors in the review Targeting Zero (1).
Victorian perinatal services performance indicator report (2) is an annual report which publicly reports on safety and quality indicators in maternity services in the state. One of these indicators is the gestation standardized perinatal mortality ratio (GSPMR) pooled over five years, which tells if observed perinatal deaths (stillbirths and neonatal deaths) are more than expected at the specified gestational age at that health service. GSPMR was reported only for health services having at least 5 deaths in at least one year of the five pooled years reported. The above-mentioned regional health service never met this threshold of reporting until 2016 and hence was missed in the data reporting. GSPMR as reported in Victorian perinatal services performance indicator 2016-17 report:
Publishing small numbers and basing inference on these is always a risk as these may not be statistically significant and are vulnerable to great fluctuation over time. This was the challenge in the above case as well.
I was looking for a methodology, sound enough to make the data transparent and meaningful, both at the same time. I found the tool in the form of a funnel plot for hospital standardized mortality ratio in the ‘patient safety’ module while completing my credits for FISQua. This is a plot of expected events on x-axis and standardized ratio on y-axis. I tested it with the experts at Safer Care Victoria, a government administrative office in the state which produces the Victorian perinatal services performance indicator report and drives safety and quality improvement in the sector. The idea clicked and below is what we published in 2017-18 report 2:
This approach worked in publishing data on all health services, irrespective of their size and making the data more visible and hence transparent. This helps Safer Care Victoria to monitor the performance of all maternity and newborn health services and support those needing improvement in maternity and newborn care in Victoria.
FISQua module provided a good methodology to tackle the problem. We got great feedback from the health services using this data and will keep on working on further refinement of this indicator.
I am grateful to Safer Care Victoria for the opportunity to complete the ISQua Fellowship program as a part of my professional development. The views expressed in this article are my own.
By Dr. Shirin Anil, MBBS, MSc. Epi & Bio, FISQua, EEF Nutr Epi, Manager Consultative Councils, Safer Care Victoria, Melbourne, Australia.
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1. Duckett, S. (2017). Targeting zero, review of hospital safety and quality assurance in Victoria.
2. Hunt RW, Davey M-A, Ryan-Atwood TE, Hudson R, Wallace E, Anil S on behalf of the Maternal and Newborn Clinical Network INSIGHT Committee. (2018), Victorian perinatal services performance indicators 2017–18, Safer Care Victoria, Victorian Government, Melbourne. Available at: https://www.bettersafercare.vic.gov.au/reports-and-publications/victorian-perinatal-services-performance-indicators-reports