Research Activities, August 2013
Patient Safety Indicators for hemorrhage and infections can be adapted for use in childbirth
Patient Safety Indicators (PSIs) are intended to provide a low-cost screening tool to identify complications or adverse events that may be amenable to change through the implementation of hospital system-level changes. Although three PSIs are specifically focused on birth trauma to the mother or newborn, other key safety indicators, such as those related to hemorrhage and infection, exclude pregnancy. The rationale for the exclusion of pregnant women has remained unclear.
A new study found that hospital-level measures of childbirth-associated hemorrhage and infection are feasible, vary widely, and demonstrate considerable opportunity for improvement. To be adapted for use with pregnant women, both PSIs required major changes to the technical specifications because of pregnancy-specific codes and coding practices, note the researchers.
To examine the potential of the two PSIs to include pregnant women, they used data on 508,842 patient discharges from the 2009 California Patient Discharge Dataset. For all deliveries, the hemorrhage indicator rate was higher (2.5 percent) than in the total population (0.26 percent) and for nonpregnant women of reproductive age (0.18 percent). Although infection rates were lower for all deliveries than for the total population (0.18 percent vs. 1.20 percent), they were highly associated with cesarean versus vaginal birth (0.43 percent vs. 0.05 percent) and ranged from 0 to 1.5 percent across hospitals.
Although the two measures could not be combined with the AHRQ PSIs as currently defined, they both identified important conditions that varied widely across hospitals. This suggests that a modified version of these indicators may have a role in monitoring care for women experiencing childbirth. This study was supported by AHRQ (HS17713).
See "AHRQ Patient Safety Indicators: Time to include hemorrhage and infection during childbirth," by Kimberly D. Gregory, M.D., Lisa M. Korst, M.D., Ph.D., Michael C. Lu, M.D., and Moshe Fridman, Ph.D., in the March 2013 Joint Commission Journal on Quality and Patient Safety 39(3), pp. 114-122.