Table 35 'Birth Trauma - Injury to Neonate'

PSI 34: Birth Trauma – Injury to Neonate
Review of OECD/AHRQ/CIHI PSI (3;33)
Dimension Description
Description of Specific
Aspects of Patient Safety
A US study regarding newborns with a discharge diagnosis of birth
trauma found that 25% had sustained a significant injury to the head,
neck, or shoulder. Birth trauma injury is preventable, making birth
trauma a suitable measure of patient safety.
Aim of the PSI This indicator is intended to flag cases of birth trauma for live born
infants born in hospital.
Level of Determination of
Patient Safety
Safety is assessed at the aggregated patient level.
Source(s) This indicator was proposed by Miller et al. (2001) in the original
“AHRQ INDICATOR Algorithms and Groupings,” although their
definition also includes injury to the brachial plexus (767.6), which
was excluded from this PSI. Based on expert consensus panels,
McKesson Health Solutions included a broader version of this
indicator (767.xx) in its Care Enhance Resource Management Systems,
Quality Profiler Complications Measures Module (3).
Modified this PSI is included in the Danish National Board of Health’s
Obstetric Indicators.
Extent of Clinically
Testing
This indicator has been widely used in the obstetric community,
although it is most commonly based on chart review rather than
administrative data (3).
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 (33).
The AHRQ project team developing the PSI conducted empirical
analyses on this PSI. The overall usefulness of this indicator was rated
as favourable. Birth Trauma generally performs well on several
different dimensions, including reliability, relatedness of indicators,
and persistence over time (3).
AHRQ is determining the feasibility and practicality in a project
concerning validation of selected AHRQ Quality Indicators (8).
This indicator may require further discussion as the WHO has data
concerning the deaths of neonates in all settings (33).
The results suggest that this PSI may be useful as a measure of patient
SImPatIE WP4 – Catalogue of Patients Safety Indicators
88
safety (3;33).
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 birth trauma, injury to neonate, per 1000 live born births.
Numerator Description Discharges with ICD-9-CM code for birth trauma in any diagnosis
field.
Exclude infants with
− A subdural or cerebral hemorrhage (subgroup of birth trauma
coding) and any diagnosis code of pre-term infant (denoting birth
weight of less than 2,500 grams and less than 37 weeks gestation
or 34 weeks gestation or less).
− Injury to skeleton (767.3, 767.4) and any diagnosis code of
osteogenesis imperfecta (756.51).
The OECD-panel decided to use Perinatal death/loss of function
(SY058) as fallback for SY019 if data are not widely available for the
later. SY058 comes from JCAHO sentinel events. It measures the
number of perinatal deaths unrelated to a congenital condition in an
infant having a birth weight greater than 2500 grams (33).
Denominator Description Discharges with ICD-9-CM codes for birth trauma in any diagnosis
field per 100 live born births.
Data Source Administrative data – hospital morbidity data collection.
Identifying the
institutional context
Birth trauma can lead to prolonged disability of the infant requiring
substantial resources for rehabilitation and care making this PSI theme
important in clinical, quality and economic policies.
Care Setting This 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
Risk adjustment: Sex.
Stratification by
Vulnerable Populations
No stratification.
Standard of Comparison No specific standards given.
Scoring AHRQ has PSI software for scoring.