- Email: [email protected]
169: Developing a comprehensive quality and patient safety program to effectively reduce obstetrical adverse events in an integrated children’s hospital system
Poster Session I
ajog.org
(DRG) relative weight (www.CMS.gov). The relationship between variables over time was assessed by Spearman’s rank correlation coefficient (rho). RESULTS: From March of 2012 through May of 2016, there were 308 deliveries complicated by one or more maternal or neonatal events amongst 22,406 deliveries, for a mean OBAE rate of 1.37%. During this time interval, the mean OBAE rate significantly decreased by almost half, despite the significant increase in delivery volume and patient acuity as reflected by CMI (Table). For example, the significant decreasing trend in pathological umbilical blood acidemia as validated by universal sampling (Spearman’s rho ¼ -0.427, p ¼ 0.002) was attributed to the institution of Category II fetal heart rate guidelines, a labor partogram, mandatory online education, and SBAR simulations. CONCLUSION: Improvements in perinatal care can be driven by integrating data analytics within a comprehensive interprofessional quality and patient safety program, serving to identify opportunities to improve structures and processes, which reduce adverse maternal and neonatal outcomes. Such improvements can be achieved even in the face of a rapidly expanding delivery volume and increasing CMI.
170 The association between weighted Adverse Outcome Index score and race/ethnicity in the U.S Yvonne W. Cheng1, Lynn M. Yee2, Aaron B. Caughey3
169 Developing a comprehensive quality and patient safety program to effectively reduce obstetrical adverse events in an integrated children’s hospital system 1
2
1
1 California Pacific Medical Center, San Francisco, CA, 2Northwestern University Feinberg School of Medicine, Chicago, IL, 3Oregon Health & Science University, Portland, OR
OBJECTIVE: Adverse Outcome Index (AOI) was developed as a quality 2
Gary Dildy , Frances Kelly , Audra Timmins , B. Wycke Baker , Lynda Tyer-Viola2, Joseph Hagan2, Minerva Franco2, Steven Clark1, Michael Belfort1 1
Baylor College of Medicine, Houston, TX, 2Texas Children’s Hospital, Houston, TX
OBJECTIVE: We sought to measure and improve perinatal outcomes
at an academic hospital, in part by participating in the Children’s Hospitals’ Solutions for Patient Safety (SPS) program. STUDY DESIGN: The SPS-sponsored obstetric adverse event (OBAE) rate is a composite of 12 outcome metrics which reflect obstetrical quality and patient safety, including 8 maternal measures (death, uterine rupture, unplanned ICU admission, unplanned return to OR, fourth degree laceration, erythrocyte transfusion 4 units, venous thromboembolism, unplanned hysterectomy) and 4 neonatal measures (early term elective delivery, brachial plexus injury, pathological umbilical blood acidemia, 5-minute Apgar score <4). Elements of the OBAE composite were evaluated monthly by an interprofessional team to focus upon revision of structures and processes (e.g. policies, guidelines, staffing, education, peer review and simulations) in order to improve patient outcomes. Maternal acuity was estimated by averaging the monthly case mix index (CMI) for discharges, representing the average diagnosis-related group
measure in obstetric care. We aim to examine the association between weighted AOI and race/ethnicity. STUDY DESIGN: This was a retrospective cohort study of live births in the U.S. between 2011 and 2013 that were period-linked with infant death that occurred during the study period. We identified pregnancies with adverse maternal outcomes (uterine rupture during labor, unplanned maternal admission to ICU, unanticipated operative procedure [excluding cesareans], maternal blood transfusion, and 3 or 4 perineal laceration) and deliveries with adverse neonatal outcomes (in-hospital neonatal death 2500gms and 37 weeks gestation, admission to NICU of neonates 2500gms and 37 weeks gestation, 5-minute Apgar <7, and birth trauma). These adverse outcomes were assigned weighted scores (ranging from 400 for neonatal death to 5 for 3 or 4 perineal laceration) to account for the relative severity of an adverse outcome (Nielson et al, Obstet Gynecol 2007). The weighted AOI score (WAOIS) was examined as a categorical variable: 0, 1-25, 26-399, and 400. The association between race/ ethnicity (White, Black, Latina, Asian, and Other/Unknown) and weighted AOI score was examined using chi-square test and multivariable logistic regression, controlling for potential
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S113
ajog.org
(DRG) relative weight (www.CMS.gov). The relationship between variables over time was assessed by Spearman’s rank correlation coefficient (rho). RESULTS: From March of 2012 through May of 2016, there were 308 deliveries complicated by one or more maternal or neonatal events amongst 22,406 deliveries, for a mean OBAE rate of 1.37%. During this time interval, the mean OBAE rate significantly decreased by almost half, despite the significant increase in delivery volume and patient acuity as reflected by CMI (Table). For example, the significant decreasing trend in pathological umbilical blood acidemia as validated by universal sampling (Spearman’s rho ¼ -0.427, p ¼ 0.002) was attributed to the institution of Category II fetal heart rate guidelines, a labor partogram, mandatory online education, and SBAR simulations. CONCLUSION: Improvements in perinatal care can be driven by integrating data analytics within a comprehensive interprofessional quality and patient safety program, serving to identify opportunities to improve structures and processes, which reduce adverse maternal and neonatal outcomes. Such improvements can be achieved even in the face of a rapidly expanding delivery volume and increasing CMI.
170 The association between weighted Adverse Outcome Index score and race/ethnicity in the U.S Yvonne W. Cheng1, Lynn M. Yee2, Aaron B. Caughey3
169 Developing a comprehensive quality and patient safety program to effectively reduce obstetrical adverse events in an integrated children’s hospital system 1
2
1
1 California Pacific Medical Center, San Francisco, CA, 2Northwestern University Feinberg School of Medicine, Chicago, IL, 3Oregon Health & Science University, Portland, OR
OBJECTIVE: Adverse Outcome Index (AOI) was developed as a quality 2
Gary Dildy , Frances Kelly , Audra Timmins , B. Wycke Baker , Lynda Tyer-Viola2, Joseph Hagan2, Minerva Franco2, Steven Clark1, Michael Belfort1 1
Baylor College of Medicine, Houston, TX, 2Texas Children’s Hospital, Houston, TX
OBJECTIVE: We sought to measure and improve perinatal outcomes
at an academic hospital, in part by participating in the Children’s Hospitals’ Solutions for Patient Safety (SPS) program. STUDY DESIGN: The SPS-sponsored obstetric adverse event (OBAE) rate is a composite of 12 outcome metrics which reflect obstetrical quality and patient safety, including 8 maternal measures (death, uterine rupture, unplanned ICU admission, unplanned return to OR, fourth degree laceration, erythrocyte transfusion 4 units, venous thromboembolism, unplanned hysterectomy) and 4 neonatal measures (early term elective delivery, brachial plexus injury, pathological umbilical blood acidemia, 5-minute Apgar score <4). Elements of the OBAE composite were evaluated monthly by an interprofessional team to focus upon revision of structures and processes (e.g. policies, guidelines, staffing, education, peer review and simulations) in order to improve patient outcomes. Maternal acuity was estimated by averaging the monthly case mix index (CMI) for discharges, representing the average diagnosis-related group
measure in obstetric care. We aim to examine the association between weighted AOI and race/ethnicity. STUDY DESIGN: This was a retrospective cohort study of live births in the U.S. between 2011 and 2013 that were period-linked with infant death that occurred during the study period. We identified pregnancies with adverse maternal outcomes (uterine rupture during labor, unplanned maternal admission to ICU, unanticipated operative procedure [excluding cesareans], maternal blood transfusion, and 3 or 4 perineal laceration) and deliveries with adverse neonatal outcomes (in-hospital neonatal death 2500gms and 37 weeks gestation, admission to NICU of neonates 2500gms and 37 weeks gestation, 5-minute Apgar <7, and birth trauma). These adverse outcomes were assigned weighted scores (ranging from 400 for neonatal death to 5 for 3 or 4 perineal laceration) to account for the relative severity of an adverse outcome (Nielson et al, Obstet Gynecol 2007). The weighted AOI score (WAOIS) was examined as a categorical variable: 0, 1-25, 26-399, and 400. The association between race/ ethnicity (White, Black, Latina, Asian, and Other/Unknown) and weighted AOI score was examined using chi-square test and multivariable logistic regression, controlling for potential
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S113