Introduction of Adverse Outcomes Index to Assess Quality of Obstetrical Care in a Wyoming Hospital

Purpose:
Identification and introduction of standardized quality indicators for Obstetrics, which will allow tracking of outcomes and development of benchmarks for obstetrical care.
Summary:
No nationally accepted set of quality indicators exists for obstetrics, and the few indicators which are tracked are of questionable usefulness.
Working with Marsh, the captive insurance group for Wyoming Medical Center and 17 other western hospitals, three new quality improvement tools were identified and adopted in January of 2007. The tools are Adverse Outcomes Index (AOI), which is the percent of deliveries with one or more adverse events; Weighted Adverse Outcome Score (WAOS), which describes the adverse event score per delivery; and the Severity Index (SI), which describes the severity of the outcomes. We are collecting data related to delivery outcomes and are using that data to benchmark Obstetrical care within our hospital and the other facilities in our Captive.
Our project is based on work described in “Assessing Quality in Obstetrical Care: Development of Standardized Measure”, by Mann S., Pratt S., Gluck P., Nielsen P., Risser D., Greenberg P., Marcus R., Goldman M., Shapiro D., Pearlman M., Sach B., in the Joint Commission Journal on Quality and Patient Safety, 2006 Sept: 32(9): 497-505. A group from Harvard used consensus development conferences to develop standardized measures and criteria. The participants, included ACOG, AWHONN, ASA and several others interested in looking at quality measures for obstetrics. The measures were trialed using data gathered from 224,661 deliveries in 49 hospitals
Using the data identified from this research, Wyoming Medical Center and associated hospitals began tracking the AOI, WAOS and the SI in January 2007. An interdisciplinary team was established to develop the data collection and reporting process.
Our average scores for the first 2 quarters of 2007 are AOI: 5.7%, WAOS: 0.62, and SI: 11.
We are comparing them to the benchmark scores identified in the research (AOI: 9.2%, range 5.9-16.6%; WAOS: 3.0, range 1.0-7.0: and SI: 25, range 10-39) and against the captive hospital scores.
Implications for Practice:
Patient safety initiatives are focused on eliminating preventable causes of adverse outcomes; especially those caused by medical error. By identifying problem areas in our facilities (bench marking and comparing against other facilities) and learning from those facilities that have good outcomes, we will decrease the number and severity of adverse events. By using standardize sets of data collection we hope to be able to identify those places that have good outcomes and identify the best practices for providing care to laboring women and their infants.