women's and children's hospital adelaide

Public Health Research Unit

The Public Health Research Unit is one of four hospital-based clinical epidemiology units funded by site-specific grants from the SA Department of Health. The Unit plays a strong support role in the planning and provision of efficient, effective and appropriate services, and in achieving better health outcomes for consumers and their communities. It also provides substantial support in the analysis of data generated by a wide range of research projects conducted throughout the hospital.

In recent times the Unit has become closely involved with clinical governance issues - in particular issues relating to the safety and quality of the services the hospital provides.

The Unit has three full-time WCH funded staff members and one part time member. Other staff members are supported by grants.

Current research

WCH Strategic Directions Goal 1 (Excellence in Health Care)

Strategy 1.2.1 Regularly benchmark clinical services

Strategy 1.2.6 Advance processes for maintenance and improvement in clinical care

• A model for predicting Caesarean section has been developed from the state-wide pregnancy outcome database and used to demonstrate that there is a two-fold variation in the risk-adjusted section rates of individual obstetric consultants within the hospital. A regular feedback mechanism is being developed in consultation with the consultants in order to stimulate reflection on practice - and in 2004 this variation in section rate will be correlated with recorded outcomes for mother and baby.

• Using a risk-adjusted model for predicting death in Paediatric Intensive Care, cumulative sum (or cusum) charts have been developed in order to detect, as sensitively as possible, any shift away from the currently accepted death rate (of around 3.8%). No significant departures from the accepted rate were detected for the WCH, but the monitoring system detected situations requiring close scrutiny at two other centres which were contributing the benchmarking data.

• A system to enable individual trainee clinicians to record outcomes of procedures carried out in the Women's and Babies' Division using hand-held Personal Digital Assistants will be ready for trialing with the new intake of trainees at the end of January 2004. The outcomes will be recorded using web-based software and wireless access points installed throughout the Division. Cusum techniques will be used to detect targeted opportunities for increased training in a blame free environment.

Strategy 1.2.4 Increase consumer participation in the WCH

• Early in 2004 a survey was initiated to look at the quality of communication between doctors attending assisted deliveries (requiring forceps, ventouse, or caesarean section) and the women in their care.