Back in April 2016 the NHS Fetal Anomaly Screening Programme introduced a new key performance indicator (KPI).
The KPI measures coverage of the 18+0 to 20+6 week fetal anomaly scan (18 weeks and 0 days to 20 weeks and 6 days of pregnancy) and is called FA2. We'd already piloted it with 10 ultrasound departments across England.
The pilot showed that there were lots of challenges, but that there would be huge benefits in introducing this KPI.
Challenges
These included:
- tracking each woman through the system
- tracking women who book and subsequently miscarry or terminate the pregnancy
- getting IT systems to help, especially where there are multiple IT systems that do not talk to each other
- women moving from one provider to another during pregnancy, sometimes several times
- following up of women who do not attend appointments
- accommodating women at short notice, for example women who book later in the gestational window due to capacity issues in many ultrasound departments
- reporting data due to the extended lag time between booking and completing the fetal anomaly scan
- the fetal anomaly ultrasound scan may not be uniquely identified from other pregnancy scans on IT systems
The pilot sites showed that many of these challenges could be overcome by collaborative working, albeit with some tenacity.
Benefits
One provider in the pilot identified 4 women who did not have their scans in the recommended timeframe. They had not looked at this or understood what was going wrong to allow this to happen. The pilot enabled them to fix problems in their appointment booking process and to provide more training for staff.
The pilot showed that pre-conceived beliefs about women always attending their scan appointments were wrong and those women who didn't attend were often the most vulnerable.
Another provider commented:
This is a useful KPI and has been well received by our Trust. It has also highlighted a gap in our failsafe for women who do not attend their anomaly scan which has now been rectified but may not have been identified as a gap without the introduction of this KPI.
Current situation
We are in a good place thanks to the hard work of all providers involved. This KPI highlights the hard work of dedicated staff, particularly local screening coordinators and ultrasound staff. We also know that where IT/audit departments have got involved that it has certainly helped to reduce some of the manual and time consuming processes.
In just 3 quarters we saw improvements in:
- data completeness (the number of providers submitting complete data)
- data quality (the number of providers submitting valid data)
- performance (measured against acceptable threshold of ≥90% and an achievable threshold of ≥95.0%)
We expect the improvement in data quality to continue due to the regional data workshops delivered by the antenatal screening programmes. These workshops have supported providers in understanding the data requirements and reporting processes.
Data completeness
| Quarter | Completeness |
| Q1 | 83 / 145 (57.2%) |
| Q2 | 98 / 145 (67.6%) |
| Q3 | 103 / 145 (71.0%) |
Data quality
| Quarter | Number of returns | Number valid returns | % of valid returns |
| Q2 | 98 | 79 | 80.6% |
| Q3 | 103 | 80 | 77.7% |
Data performance
| Quarter | Performance (%) |
| Q1 | 95.0% |
| Q2 | 96.3% |
| Q3 | 97.0% |
Next steps
We want to be in a position where we have data that is complete and of good quality from all providers in England. This KPI is a vehicle for improving the screening pathway and making sure all eligible women are offered a scan and those who accept the offer of screening complete screening.
It will help us to focus our work on reducing the number of women having scans outside of the recommended timeframe and addressing 'did not attend' appointment rates.
If you're already submitting complete high quality data we'd really like to thank you. Do still have a look at the learning from the pilot sites to see if this can help you in any way.
If you're not already submitting data we'd like to encourage you to work towards that. You may find the learning from the pilot sites helpful in setting up systems to start or improve how you collect and submit data for this KPI.
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