Table 33 'Obstetric Trauma - Cesarean Delivery'

PSI 32: Obstetric Trauma – Cesarian Delivery
Review of OECD/AHRQ PSI (3;33)
Dimension Description
Description of Specific
Aspects of Patient Safety
Obstetric trauma during delivery: vaginal or cesarian is often
preventable. Thus trauma during cesarian delivery is a suitable measure
of patient safety.
Aim of the PSI This PSI is intended to flag cases of potentially preventable trauma
during cesarian delivery.
Level of Determination of
Patient Safety
Safety is assessed at the aggregated patient level.
Source(s) An overlapping subset of this indicator (third- or fourth-degree perineal
laceration) has been adopted by the Joint Commission for the
Accreditation of Healthcare Organisations (JCAHO) as a core
performance measure for “pregnancy and related conditions” (PR-25).
Based on expert consensus panels, McKesson Health Solutions
included the JCAHO indicator in its Care Enhance Resource
Management Systems, Quality Profiler Complications Measures
Module. Fourth degree laceration, one of the codes mapped to this
indicator, was included as one component of a broader indicator:
“obstetrical complications” in AHRQs original HCUP Quality
Indicators (3;33).
Extent of Clinically
Testing
The OECD Health Care Quality Indicators (HCQI) Project was
initiated to implement quality measures for international benchmarking
of medical care at the health system level. Five priority areas including
patient safety were selected. International expert panels were formed to
identify clinically important, scientifically sound, and feasible
measures based on a structured consensus process. The consensus
process was successfully completed in all five priority areas leading to
a recommendation of 86 indicators of which 21 cover patient safety
(3;33).
The OECD PSI panel assessed the indicator to be well operationalised.
Though concluding: “However, it may be necessary to exclude or
adjust for additional high-risk conditions to ensure comparability of
this indicator across countries” (33).
The AHRQ project team developing the PSI conducted empirical
analyses on this PSI. This PSI generally performs well on several
different dimensions, including reliability, relatedness indicators, and
persistence over time (3).
The results suggest that this PSI may be useful as a measure of patient
safety (3;33).
AHRQ is determining the feasibility and practicality in a project
concerning validation of selected AHRQ Quality Indicators (8).
SImPatIE WP4 – Catalogue of Patients Safety Indicators
84
Evidence of Clinically use
of Standards
No evidence of clinically use of standards was found.
PSI category Theme Related PSI: “Obstetrics”.
Data definitions Cases of obstetric trauma (third or fourth degree lacerations) per 1000
Cesarian deliveries.
Numerator Description Discharges with ICD-9-CM codes for obstetric trauma in any diagnosis
or procedure field.
Denominator Description All cesarian delivery discharges.
Data Source Administrative data.
Identifying the
institutional context
Complications to delivery can have an ongoing burden on the hospital
system in increased length of stays and readmissions making this PSI
theme important in clinical, quality and economic policies.
Care Setting The PSI applies for high quality maternity care.
Professionals Responsible
for Health Care
Midwifes and doctors.
Lowest Level of Health
Care Delivery Addressed
Individual clinical department.
Allowance for Patient
Factors
No risk adjustment.
Stratification by
Vulnerable Populations
No stratification given.
Standard of Comparison No specific standards given.
Scoring AHRQ has PSI software for scoring.