Hospital halves number of babies born with brain damage by implementing NICE guidance

BMJ 2008; 337 doi: (Published 11 December 2008) Cite this as: BMJ 2008;337:a2960
  1. Lisa Hitchen
  1. 1Manchester

    Deaths and brain damage among newborn babies have fallen considerably at a Bristol hospital after staff changed their practice by applying guidelines from the National Institute for Health and Clinical Excellence (NICE).

    In 2000 the maternity unit at North Bristol NHS Trust introduced training in the interpretation of electronic fetal monitoring and made it mandatory for all staff to train every year. It also devised forms for reporting the number of infants that needed resuscitation at birth and the incidence of severe hypoxic-ischaemic encephalopathy, and it developed a surveillance system to detect periods when standards slipped.

    Between January 1998 and December 1999 27.3 infants per 10 000 births were born with brain damage, and 86.6 infants per 1000 births needed resuscitation at birth. But after the introduction of the new surveillance methods (between January 2001 and December 2003) these rates fell to 13.6 per 1000 births for infants born with brain damage and 44.6 per 10 000 births for babies who needed resuscitation. These improvements were sustained until August 2006 when the surveillance system picked up an increase in infants who needed resuscitation (up to 67 per 10 000 births).

    The team looked at why the numbers were rising. The main problem was a lack of undergraduate training in this area for some staff, which they tackled with targeted mentorship schemes. Within a month, this led to a lower incidence of infants needing resuscitation, of 34 per 10 000 births. Incidence continued to remain low from then on.

    “We had regular multiprofessional case reviews and audit to monitor compliance and make further improvements,” said Dimitrios Siassakos, honorary clinical lecturer in obstetrics and gynaecology at the trust. “We also kept updating our training materials and proformas in line with new NICE guidelines. Our team aims to continue prospective monitoring of several perinatal outcomes in our unit and disseminate our methods and lessons regionally, nationally, and internationally.”

    The trust was the overall winner in the NICE 2008 shared learning awards, where health staff find innovative ways to implement NICE guidance and achieve better outcomes for their patients.

    Other shortlisted campaigns included one to raise the profile of long acting reversible contraception, one to help hospital inpatients to stop smoking, and one to reduce alcohol consumption among 11-15 year olds.

    Staff at North Lincolnshire NHS Primary Care Trust used posters and cinema adverts to raise the profile of long acting contraception and provided training for health staff to fit the implants. Services that offer advice and fitting were extended to locations, such as schools and colleges, and times acceptable to women aged 15-25.

    Since April 2007 the trusts have seen a 91% rise in the use of the implants in the 15-25 age group and a 52% rise in the use of long acting reversible contraception methods overall. The number of implants fitted rose from 432 in 2006-7 to 826 in 2007-8.

    The campaign is now targeting young men, with its unique selling point being that it is the only contraceptive that men can be certain has been used because they can feel the implant in the arm of their partner, said Lynnette Smith, one of the coordinators of the campaign.

    Staffordshire County Council has tackled its underage drinking problem by using marketing tools as well as education, web technology, and enforcement through Trading Standards to prevent underage sales.

    From 2006 to 2008, its programme led to a reduction from 33.1% of 17 000 young people from 23 secondary schools reporting consuming 6.9 units of alcohol a week to 26.5% consuming 6.6 units of alcohol a week.

    “Looking at the data, it seems that it is the younger pupils who are choosing not to drink so we are delaying experimentation with alcohol,” said Martin Wilcock, adviser for alcohol education in Staffordshire.

    Students were keen to develop skills to withstand peer pressure to drink and it was this they were particularly receptive to rather than knowing about the physical health risks of drinking, he added.


    Cite this as: BMJ 2008;337:a2960