First mortality surveillance report published for trusts and health boards
Published: 15 Dec 2015
UK NHS Trust and Health Board stillbirth and neonatal death rates published for first time
Today MBRRACE-UK* is publishing the first perinatal mortality surveillance report for Trusts and Health Boards in the UK. Commissioned by Healthcare Quality Improvement Partnership**, this is a Supplement to the MBRRACE?UK perinatal mortality surveillance report for births in 2013 published in June 2015 https://www.npeu.ox.ac.uk/mbrrace-uk/reports. (see NOTE 1)
The purpose of this Supplement is to enable individual Trusts and Health Boards to understand their local stillbirth, neonatal death and extended perinatal death mortality rates and to give local teams an insight into clinical performance based not just on crude mortality rates but also having taken account of at least some important socio-demographic factors that influence pregnancy outcomes.
The report released today (Dec 16) presents data for UK births in 2013 and maps out the country by NHS Trusts and Health Boards using a traffic light system with a Red, Amber, Yellow or Green rating highlighting variation in death rates:
- mortality more than 10% lower than the average for the comparator group
- mortality up to 10% lower than the average for the comparator group
- mortality up to 10% higher than the average for the comparator group
- mortality more than 10% higher than the average for the comparator group
In today’s report, deaths have been allocated on the basis of where the baby was born (even if the death subsequently occurred in a different organisation). In order to deal with the variation in the proportions of high and low risk pregnancies delivered by the different NHS Trusts and Health Boards they have been divided into five groups based on the complexity of neonatal care they are able to provide or, for those organisations without the highest levels of specialised neonatal care locally, by the number of births. The five groups of NHS Trusts and Health Boards are as follows:
- Level 3 Neonatal Intensive Care Unit with routine neonatal surgical provision;
- Level 3 Neonatal intensive care unit;
- 4,000 or more births per annum at 24 weeks or later;
- 2,000-3,999 births per annum at 24 weeks or later;
- Less than 2,000 births per annum at 24 weeks or later.
NHS Trusts and Health Boards have then been rated within groups, comparing their mortality rate to the group average, using the traffic light system with guidance provided as to the action required based on their rating. In line with the previous report published in June all babies born before 24 weeks of gestation have been excluded.
As with any analysis this complex method does not guarantee that all NHS Trusts and Health Boards are compared on an entirely equal basis as not all variation in underlying case mix differences in the populations they serve can be removed. However the grading system acts as a means of flagging potentially important differences in performance to local clinical teams. Trusts and Health Boards graded in the red or orange bands are advised to carry out reviews of all stillbirths and neonatal deaths in order to identify areas of practice where additional training is required or where improvements in care should be initiated.
Trusts and Health Boards in the yellow or green bands are also advised to carry out reviews of all their stillbirths and neonatal deaths if their aspiration is not simply to be average but to seek levels of clinical performance that compare with those achieved in other parts of the developed world.