Continuous real-time monitoring of extended perinatal mortality in the UK and Crown Dependencies

Extended perinatal mortality (stillbirths and neonatal deaths) in the UK and Crown Dependencies is monitored by MBRRACE-UK, a national surveillance programme. Extended perinatal death of babies delivered within individual maternity and neonatal care providers in a previous year are analysed and presented in the form of extended perinatal mortality rates in the MBRRACE-UK Perinatal Mortality Surveillance Report. Aggregate analysis such as this masks unexpected fluctuations in the incidence of mortality, thus concealing high or low rates of the adverse outcome in the organisations. Furthermore, uncovering the reasons for a high or low rate of mortality from past data results in delayed opportunities for learning and implementing appropriate initiatives, consequently delaying the reduction of avoidable extended perinatal deaths.This PhD is in collaboration with MBRRACE-UK to improve the surveillance of extended perinatal mortality in healthcare. Statistical process control methodology is investigated for prospective and continuous monitoring of extended perinatal mortality. The methodology is studied for individual Neonatal Networks, Trusts and Health Boards across the UK and Crown Dependencies as part of national surveillance, with the view of implementation by MBRRACE-UK. Statistical process control methods have been endorsed in healthcare to monitor poor patient outcomes; however, their utility in perinatal medicine to reliably detect a high or low rate of a rare adverse outcome such as extended perinatal mortality in a timely manner is unclear when:1. The sociodemographic information on births is not available to MBRRACE-UK in a timely manner from multiple statutory sources.2. The organisations have different number of annual births and extended perinatal deaths.3. The probability of extended perinatal mortality varies for each birth due to their individual risk profile.These issues are explored in detail in the thesis.