Women's Hospital Dangerously Overloaded

[BellyBelly]

Women's hospital 'dangerously overloaded'

* Nick Miller
* September 9, 2008

DOCUMENTS leaked from the Royal Women's Hospital show that it is "dangerously overloaded", resulting in an unprecedented level of risk to women and babies.

Exhausted and demoralised staff are trying to cope with a record number of births, but key senior positions and up to 20 midwife positions remain vacant, the documents reveal.

The CEO of the Royal Women's Hospital says the facility continues to provide first class care despite a leaked document outlining serious internal concerns.

The Royal Women's and Premier John Brumby yesterday defended the hospital after The Age revealed an internal report warning that a lack of resources was putting women and babies in danger. They said the risks were being well handled by staff despite the baby boom, and that Victorian women were in safe hands.

But an internal safety committee at the Royal Women's has written a scathing report on its maternity services. "I have never seen so many adverse outcomes and near-miss events," the report writer, a senior consultant, said after reviewing 14 case histories from June this year. "The hospital is dangerously overloaded with maternity cases. The hospital is not capable of safely handling 7000 deliveries per year."

More than 600 babies were born at the Women's in July ? a 10-year high that puts the hospital on track for well over 7000 babies a year. In the same month, it had a record 1109 requests for bookings.

The report, seen by The Age, warns that overworked staff are "ignoring abnormal CTGs (foetal heartbeat monitors)" and "(this) must cease immediately pending urgent review". The report says: "All abnormal CTGs must be reviewed by the senior registrar."

It warns that the birth suite is "severely understaffed" and that "staff covering unfilled leadership roles have not had their own positions replaced".

"Following the stress of hospital relocation (in June) and limitations on leave, hospital staff are exhausted. Morale is generally poor, especially for those in leadership roles."

The hospital is reviewing five serious clinical events, involving:

■ A baby's death during labour from hypoxia (lack of oxygen).

■ Stillborn twins.

■ A newborn being given incorrect medication.

■ An ambulance en route to the hospital being diverted at the last minute, and as a result a woman giving birth to a 26-week-old baby before arrival.

In 44% of post-birth hemorrhages, there was no record that a consultant had been notified of the problem. And in 45% of emergency caesareans, there was no record that a consultant had discussed the decision.

Another report from the hospital's quality and safety committee said the high level of activity at the hospital was a contributing factor in "recent significant clinical incidents".

It proposed sending women already booked into the Royal Women's to other hospitals, and moving new mothers more quickly out of birth suites and into ambulatory or day care parts of the hospital.

Opposition health spokeswoman Helen Shardey said the new documents revealed serious fears within the hospital.

"This litany of near-disasters illustrates once again that Victoria's health system is in crisis, and John Brumby must end the denial and fix this hospital immediately," she said.

Mr Brumby said the Royal Women's provided excellent service. "I'm proud of the hospital and I'm satisfied with the work that it does," Mr Brumby said.

He said the risk management report revealed in The Age yesterday was "not to say what happens from day to day but to imagine what's the worst that could happen and how would we address it".

Royal Women's chief executive Dale Fisher said her hospital was one of the safest places to have a baby in Australia.

Ms Fisher said she was always concerned with adverse events in care at the hospital. "Our No. 1 priority is safe care," she said. "I'm never worried, because of the confidence I have in the staff managing the situation."

Ms Fisher said the new $250 million hospital, opened in June, had seen a 20% increase in demand in July and a 36% rise in requests for care. "Clearly that is not sustainable," she said. "We have encouraged women with low-risk pregnancies to birth at their local hospital."

Despite the hospital's internal documents revealing a concern about Government underfunding, Ms Fisher said: "It's not about money."

The Government had funded a recruiting drive and the hospital was looking for 12 to 20 more midwives.

She said the hospital would consider opening another operating theatre after hours to take emergency cases.

It will redesign the maternity "pod" in its outpatient area because it could not cope with the numbers. Mothers-to-be were forced to stand or sit on the floor because there were not enough chairs.

Anyone going to the women's really needs a doula or their own midwife - unfortunately because they arent going to get what they need there.

[visitor1]

I seen this on the news last night and began to think how lucky i am im not going there. How can it be this bad for a new hospital??

[Nai]

I wonder if this is the same at Frances Perry?

[BellyBelly]

It's just a joke. When are they going to re-open all those birth centres they closed? And when are they going to fund more?

[Pretty Butterfly]

That poor little bubba, and still- born twins....

I would definatly be going "homebirth" I lived down there.... What a sad and sorry state...

[2CheekyMonkeys]

which royal? in melbourne? god thats terrible!

[paradise lost]

It's a fairly obvious thing to happen though:

Scare everyone that birth is terrible and dangerous.

Open a big new state-of-the-art hospital for dealing with high-risk situations.

All the scared people want to have their low-risk pregnancies cared for at the big hospital "to be safe".

The hospital is over-subscribed by people without need. Overworked doctors end up treating everyone as high risk because there's no time for case-by-case reviews of women's situations. The hospital becomes dangerous for low risk women AND high risk women.

If people realised that hospital is for high-risk people and that the best way "to be safe" is to get APPROPRIATE care, rather than over-blown unnecessary care, these things would happen less. Of course shutting down birth centres so women have no choice BUT to go to the big shiny hospital isn't going to help matters a great deal either...

Bx

[Olive]

It's a fairly obvious thing to happen though:
Open a big new state-of-the-art hospital for dealing with high-risk situations.

All the scared people want to have their low-risk pregnancies cared for at the big hospital "to be safe".

The hospital is over-subscribed by people without need. Overworked doctors end up treating everyone as high risk because there's no time for case-by-case reviews of women's situations. The hospital becomes dangerous for low risk women AND high risk women.
If people realised that hospital is for high-risk people and that the best way "to be safe" is to get APPROPRIATE care, rather than over-blown unnecessary care, these things would happen less.

exactly what i have been thinking!
they need to lower their intake low risk births and refer people back to their local hospitals and only take those in the immediate area and those classed as high risk, this is what this hospital should be used for HIGH RISK, not everybody who wants a new public hospital with their own room!

[satya]

It's interesting reading seeing that many women seem to think that going to the RWH will somehow give them something better than what is available at their local hospital.

The stats on the deaths are hard to comment on as I think most hospitals that have maternity wards lose babies (and mothers) from time to time so this could be no worse than any other hospital.

I gave birth at Dandenong Hospital a couple of months ago and there was no noticeable shortage of staff during labour nor in the post natal ward or the special care area. If anything we got far more attention than I would ever have expected. My favourite midwife had just left the RWH and was far happier at Dandenong. She always had the time to sit on my bed and have a chat to me when things were not going as expected. I don't think that would happen at the RWH.

I think women need to put more trust back in to their local hospitals and the RWH should just concentrate on the riskier births and direct all low risk pregnancies to local hospitals - I think they are doing a lot of this anyway - maybe they need to do a bit more of it so they can cope with what they take on.

[Toomanytoomany]

It's just a joke. When are they going to re-open all those birth centres they closed? And when are they going to fund more?

I just do not understand how they can have been able to plan this hospital (and the RCH for that matter!) without including planning for expansion. I mean, they've been talking about the burgeoning need for maternity services for... how long?? How did this even get past the initial planning stages without someone saying, "Errr, folks, we haven't built any extra capacity into the system - do you think we ought to do something about that?"