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Birmingham Women’s Hospital

Birmingham Women’s Hospital. 37 th Annual Clinical Report April 2009 – March 2010 Simon Grant Consultant in Obstetrics & Fetal Medicine. My background…. Consultant in Obstetrics & Fetal Medicine Southmead since 2005 Member NICE IPC GDG 2005-7

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Birmingham Women’s Hospital

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  1. Birmingham Women’s Hospital 37th Annual Clinical Report April 2009 – March 2010 Simon Grant Consultant in Obstetrics & Fetal Medicine

  2. My background…. • Consultant in Obstetrics & Fetal Medicine Southmead since 2005 • Member NICE IPC GDG 2005-7 • Consultant in Obstetrics & Gynaecology Treliske 2000-5 • Subspecialty training in Maternal Fetal Medicine Birmingham Women’s 1996-9 • Research Southampton 1993-5

  3. Southmead - BWH • Large district general hospital compared to long-standing university unit • Full range of obstetric care except specific maternal complications & two fetal medicine procedures (proximal regional referral centre) • Some limitations of gynaecology activity at both • Developing against established research environment • Unusual situation in Bristol

  4. SMH – BWH: deliveries

  5. SMH – BWH: mode of delivery

  6. SMH – BWH: Gynaecology

  7. Scope of the report • Clinical Governance • Maternity • Gynaecology • Neonatology • Clinical Support • Genetics • Infection Control • R&D, Education • Patient Experience

  8. Clinical Governance (1) • Intranet & document management system • allows digital storage of & access to guidelines & policies; • facilitates update of documents; • Challenges: • ease of access to on-line documents • often printed anyway for “near-patient use” • rate limiting step for update of documents is the process of production

  9. Clinical Governance (2) • NHSLA Standard 2 • considerable achievement • what was prior level? • admirable commitment to reassessment against future standards • Achievement of standards • increasingly challenging • is it time to reassess the system? • BJOG December 2010

  10. Maternity (1) • KPIs • 80% bookings before 12 weeks • 75% women with named midwife • 75% continuity of carer by 2 midwives • continued increase in breastfeeding rate • smoking cessation referrals • (identification of intrauterine growth restriction)

  11. Maternity (2) • First trimester combined screening for aneuploidy • current “gold standard” for screening • can it be offered at the same level as in the private sector? • funding • staffing • training • capacity • FASP accreditation/oversight

  12. Maternity (3) • Community scanning • midwife sonographers • dating & growth scans • CoGs study • improved identification of growth restriction • Resources?

  13. Gynaecology (1) • Very high level of activity • Target achievement • Infection control a continued success • Successful ACU with successful pregnancy rates in line with national standards • Wide range of sub-speciality activity • Urogynaecology • Colposcopy • Gynae cancer • EP/AGA • PAG • Menopause • MASE

  14. Gynaecology (2) • Assisted Conception Unit • Multiple pregnancy rate reduced from 28% to 13% • With no impact on overall pregnancy rates • Significant decrease in complications of ovarian stimulation: • Reduction in abandoned cycles from ~12% to 0-3% • Apparently significant reduction in cases of ovarian hyperstimulation

  15. Gynaecology (3) • Outpatient gynaecology • Not “just” ambulatory hysteroscopy, but includes: • Menstrual disorders • PMB • Hysteroscopic sterilisation • OP endometrial ablation • Coil retrieval & contraceptive advice • Investigation and treatment of reproductive problems • Innovative • Leadership – national & wider • Research

  16. Neonatology • New premises – overwhelming effort • Joint working with BCH for neonatal surgical patients • Clinical information system • Increasing nursing staffing numbers • First submission of data to the National Neonatal Audit Project • Active contribution to unit’s research effort

  17. Clinical Support (1) • Radiology & Ultrasound • In-house & direct access gynae US service to GPs • 6.5% increase in activity from 2007/8 • 41% increase in activity over 5 years up to 2009-10 • Obstetric US: 4.8/delivery (3.1/delivery @ SMH)

  18. Clinical Support (2) • Laboratory specialities – maintained accreditation while dealing with increased workload & staffing issues • Anaesthetics: • Epidural rate increased but still below national average; • Regional analgesia satisfaction rates maintained; • Complication rates continue to decrease

  19. Clinical Support (3) • Genetics: • continued increase in staffing to address workload; • Meeting RTT targets. • Infection Control: • CQC inspection; • 7th year of lack of any mandatory surveillance infections.

  20. Research & Development • High level of stability • long established University department • Maintenance of staff & funding • tenured academic posts • support staff • High level of activity • 105 studies in progress, or in start-up, at the end of March 2010 • High rate of publication • 173 publications listed in report

  21. “New challenges” – review 2004 • More focussed research strategy? • Recruitment to major trials? • Recruitment to specialities • Maternal morbidity • Neonatal morbidity • IUGR? • Gynaecological follow up

  22. Challenges • Complaints environment • First trimester screening implementation • NHSLA/CNST standards • Financial environment • Reorganisation of NHS – GP commissioning

  23. Annual Clinical Report 2009-10 • Extremely busy unit • High levels of clinical activity in all areas • Achieving most externally set standards • Innovative • Thriving research environment

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