Due date bungle: 'Potential miscalculation' impacts SA pregnancy records
An independent investigation has been ordered to determine whether any mothers experienced "harm" as a result of incorrect due date estimates. (freestocks.org: public domain)
South Australia's health department may have "miscalculated" the due dates of more than 1,700 pregnant women, prompting concerns some could have been induced too early, ABC News can reveal.
SA Health Minister Chris Picton has ordered an independent investigation into the bungle, which impacted all metropolitan and regional public birthing hospitals across a six-month period to June 5.
SA Health is halfway through conducting its own review of medical records to determine whether any women or babies have experienced adverse health outcomes.
The department's chief executive, Robyn Lawrence, told ABC News the "majority" of women whose records were impacted have already given birth, with about 100 still pregnant.
"Of those women who were identified as having their records impacted … we've identified no subsequent adverse outcomes in them or their babies," she said.
"Of those women who remain pregnant, we've covered all of those women, and they will all be having their records rectified."
Dr Lawrence said she expected SA Health would finish reviewing the remaining 50 per cent of impacted medical records "in the next couple of weeks".
"We're doing everything we can to bring that forward," she said.
SA Health briefed Mr Picton last week, but ABC News understands the department has not informed patients whose medical records were impacted.
Dr Lawrence said the department would advise them "in due course".
"There's been no impact to those women or their babies that we can tell at the present time, which is great news," she said.
'Potential miscalculation' in electronic record system
An internal SA Health document seen by ABC News – dated June 12 and categorised as "urgent" – states the department declared a "complex cluster incident" that "resulted in potential miscalculation of Estimated Date of Deliver (EDD)/Estimated Gestational Age (EGA)" in its electronic medical record system, Sunrise.
SA Health defines a "complex cluster incident" as an incident in which "patients are impacted with serious harm, or a large number of patients are impacted with minimal or no harm, or where multiple patients are affected where significant safety implications are identified".
An estimated delivery date is initially calculated from the date of a pregnant woman's last menstrual period and is later updated following tests such as ultrasounds.
According to the internal SA Health document, when maternity admission notes were opened in Sunrise, the field containing the estimated due date was "potentially overwritten" by the last menstrual period calculation, causing the field to display "incorrect data".
As a result, clinicians may have made clinical decisions based on incorrect EDD/EGA e.g. early induction of labour, the document states.
Dr Lawrence said the error had since been fixed by SA Health.
She said she was unsure how many of the 1,700 women whose records were impacted had been induced.
"We don't tend to deliver women early unless there is a clinical reason to," she said.
'Hidden anxieties could come out of this'
But the former head of obstetrics at the Women's and Children's Hospital, Brian Peat, told ABC News that inductions were common.
He said accurate estimated due date calculations were crucial to ensuring safe deliveries.
"We're talking here about a week or two either way being potentially quite critical," he said.
"If you have an elective caesarean section at 38 weeks (gestation), for example, instead of 39, you may find that the baby has more difficulty breathing.
"We call it TTN – transient tachypnea of the newborn – that is, the baby has trouble breathing, it's breathing fast, and it needs a little bit of support with oxygen and so on to help it breathe.
"In some severe cases, babies have hyaline membrane disease, which is a much more severe form of lung problems in which they … might need intensive care."
Dr Peat said "fundamental errors" could be made if ultrasound scans were not accounted for in the calculation of estimated due dates.
"Last menstrual period is notoriously unreliable as a measure of the pregnancy," he said.
"We don't want mothers to think that their babies are not right.
"There's a lot of hidden anxieties that could come out of this."
Dr Lawrence advised concerned mothers and families to speak to their doctor or midwife.
"You can be reassured that if your record was impacted by this, we've been through those records and the error has been rectified," she said.
"If you've given birth and you've got any concerns, please reach out to your clinical team."
Commissioner to lead independent review
Mr Picton said he had asked SA's Commissioner for Excellence and Innovation in Health, Keith McNeil, to investigate "what happened, how it happened and the follow-up action that occurred".
He said he expected the investigation would take "a couple of months", with the findings to be made public.
"Any time there is an issue in terms of our medical records system we always want to make sure that it is addressed as promptly as possible," he said.
"I was very keen to speak to Dr Lawrence at our regular meeting on Monday about this issue and to make sure we were taking every step possible to both remedy the issue, but also to identify if there have been any clinical incidents that have occurred.
"I was very relieved to know that so far we haven't found any of those."
Mr Picton said if the review of the remaining 50 per cent of medical records uncovered that a woman had experienced adverse health outcomes, the government would speak to the family.
"It is far too early to speculate," he said.
"We'll continue to review all of those cases."
Australian Medical Association SA president John Williams described the bungle as a "huge concern".
"I really hope there's been no negative health outcomes for mothers or their babies," he said.
"It's really important that people have faith in the system."