MBRRACE-UK published a supplementary Supplementary Report to the report of Perinatal Mortality for Births in 2013, which provided the perinatal mortality rate for Trusts and Health Boards.The full report can be viewed here.
The report reveals individual Trusts and Health Boards local stillbirth, neonatal death and extended perinatal death mortality rates and gives an insight into clinical performance. It was based not just on crude mortality rates but also provided adjusted figures that took account of some of the important socio-demographic factors that influence pregnancy outcomes.
Deaths were allocated on the basis of where the baby was born, and hospitals were grouped by size and the complexity of neonatal care they could provide (as more advanced centres are more likely to be referred high risk cases). The report gave a traffic light rating comparing the adjusted and stabilised rate to the average for that sector.
The report recommended that Trusts and Health Boards graded with red or orange traffic lights “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. For those who are in the yellow band (and perhaps even green) any additional local review would be justified if the local 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, particularly the Nordic countries”.
The next report (featuring 2014 deaths) is due to be reported in May 2016.
Stop Still Comment: The release of this data is very welcome, whilst it does need to be interpreted with caution. Trusts will inevitably seek to argue that demographic factors outside their control determine their stillbirth rate – but given the very strong evidence that quality of care is a leading factor in stillbirth, this is disingenuous and the figures must be taken extremely seriously.
The main disappointment was that the guidance on reviewing was not strong enough, with the Perinatal Institute rightly pointing out that “all units, regardless of their baseline mortality rates, have avoidable deaths, and all deaths should undergo standardised clinical review, to ensure that learning points are translated into action plans for prevention”.
Hopefully this has been taken on board for future reports, as MBRRACE responded that “Of course good practice demands that all perinatal deaths are reviewed locally which is what we recommend that all Trusts and Health Boards do”.