Quality Improvement

NIDAY PERINATAL DATABASE
Developed and maintained by the Perinatal Partnership Program of Eastern and Southeastern Ontario (PPPESO), the Niday Perinatal Database (formerly known as the Eastern and Southeastern Ontario Perinatal Database) was first implemented in January 1997 in the Eastern and Southeastern Ontario region. The database was renamed after Patricia Niday (a driving force behind the initial development of the database), the former Executive Director of PPPESO, when she retired in 2001.

The database is a regional, Internet-based, real-time surveillance system that collects information on variables related to maternal, newborn and perinatal care characteristics, including information on details of births and obstetrical interventions. Although the Niday Perinatal Database is not the only source of information on births, it provides more timely, complete and comprehensive data on virtually all birth events, about both the newborn and mother, than other current sources of perinatal data.

Since its initial inception, the database has undergone substantial enhancements. Beginning January 1, 2001, the database was enhanced from a stand-alone computer program, to the web-based CritiCall Ontario platform. Hospitals now enter data directly into the database accessed through an Internet-based screen (managed by CritiCall) and can generate reports independently.

The issue of developing a standardized perinatal database across the GTA to collect current high-quality information had been raised on a number of occasions in the past. The major issues that prohibited advancement of this goal were related, primarily, to funding and a general lack of willingness among some partners to transfer data from their hospitals into a regional database. In January 2002, at a meeting of the Chiefs of Obstetrics for the CHN, the issue of developing a regional perinatal database re-emerged as a priority. This time, there appeared to be buy-in and willingness among the partners to move this agenda forward.

Moreover, public health units in the GTA also recognized the need for a new source of regional perinatal data. Public health epidemiologists have long been advocating for improved reproductive health data due to the limitations in existing data sources.

The success of the development and implementation of the Niday Perinatal Database in Eastern and Southeastern Ontario was well reported. After an initial meeting with the members of the CHN's Maternal and Newborn Services Task Force (April 2002), there was unanimous agreement that the database should be implemented in the GTA. All members of the CHN agreed to participate in the database project and committed to moving forward with the initiative as quickly as possible. With the help of the PPPESO, a training session was organized for CHN members that provided hospital users with an orientation session on the merits and components of the database. Formal implementation of the system began April 1, 2003.

Consistent with the successful PPPESO model, the CHN and the Public Health Units in the GTA developed a partnership to strengthen the database in the areas of data quality, regional reporting and overall utility.

FREQUENTLY ASKED QUESTIONS

WHAT IS IT?
The Niday Perinatal Database is an Internet-based system that enhances the ability of health care providers in different parts of the region and within different service sectors to work together to improve the perinatal health of the community. It is the only database in Ontario that provides immediate access to real-time population-based perinatal data for an entire region. The database uses CritiCall as a platform, a province-wide hospital system, which provides sophisticated encryption technology with multiple redundant systems to ensure data privacy, security. CritiCall provides all system maintenance and support.

WHAT INDICATORS ARE IN THE DATABASE?
The database currently includes 42 indicators for every baby that is born in the GTA (although currently only data on hospital births are available, efforts are under way through discussions with the Association of Ontario Midwives to incorporate midwifery home births into the database). It includes data on maternal characteristics, fetal outcomes, and the use of obstetrical interventions. The database variables have been carefully selected to ensure the quality of the data and cooperation by the hospitals that enter the data.

HOW IS IT USED?
Hospitals and midwives enter their own data directly into the database. Data entry takes approximately 60 seconds/record. The CHN provides training sessions for both data entry and report generation to ensure quality and consistency. Users can generate reports at any time, as required by each organization. Health units can generate reports once all the hospitals have completed entering data for the time period under study to ensure all the births from their region are included in the analyses. The CHN has prepared an interim statistical report for the GTA with data collected from the first six months of implementation (April 1, 2003 - September 30, 2003). The development of an annual statistical report is currently under way and will report on data from April 1, 2003 - March 31, 2004.

At the hospital level, the database is intended to be used as part of a Continuous Quality Improvement (CQI) system for perinatal care interventions. The database also assists hospitals and health units in meeting their accreditation requirements. The involvement of all hospitals in the region also permits the inter-hospital comparisons necessary for benchmarking, and performance improvement based on learning from other's successes. Within community organizations, the database provides population perinatal data for planning and evaluation of programs, policies and services. Within the region, the database allows the CHN to identify regional trends, continuing professional education needs, and areas for program development.

HOW TO ACCESS IT?
A brief training session is provided to all organizations in the region that need to access the perinatal database. The training includes instructions on how to use the report screens, a review of definitions for indicators collected, and guidelines for interpretation of results. Password protected logins ensure that hospitals have access only to their own data, though all organizations using Niday throughout Ontario will have access to aggregate regional data for comparison purposes.

HIGHLIGHTS OF THE FOURTH ANNUAL STATISTICAL NIDAY PERINATAL DATABASE REPORT (2006/07)
Data presented in the 4TH Annual Statistical Niday Perinatal Database Report are based on births between April 1, 2006 and March 31, 2007 at the 24 participating CHN member hospital sites (representing 19 hospital organizations) and 15 midwifery practices. For the first time, the report features an analysis of the data from a LHIN perspective. The analysis and recommendations included in the report provides an opportunity to improve planning and inform quality improvement, and to benchmark and evaluate initiatives at the hospital, LHIN, and provincial levels.