QUALITY IMPROVEMENT David Conway, MD, FACOG. DISCLOSURE I have no conflicts of interest to disclose.

QUALITY IMPROVEMENT

David Conway, MD, FACOG

DISCLOSURE

I have no conflicts of interest to disclose

INTRODUCTION

Dr. Jerome Schlachter - Confidential Peer Review Board - CPRB

Dr. Timothy Fisher – Patient Safety Organization - PSO

Why are we here?

To improve the quality and safety of health care delivery

Reduce harm to patients

Who are we?

Diverse organization committed to quality Tertiary centers Community hospitals Birth centers

Who are we?

Diverse group of providers OB/GYNs

Faculty Private practice

Family physicians

Midwives Certified Nurse Midwives Lay midwives

How do we maximize quality as PSO?

Propose that each member have a QA process in place

Establish regional guidelines

Review outcomes as consultant

Developing a Q I Program

Background Increase the likelihood of desired health outcomes

Hospitals continually evaluate care

Continuous improvement vs. punitive

Educational vs. punitive

Getting organized

Requires effective leadership

Requires cooperation by members

Developing tools

Clinical pathways Must document rationale for deviation

Quality indicators a measurable dimension

Outcomes – eg, previa Processes – eg, VBAC

provider profiles benchmarked to local, regional, national

identify trends thresholds

Developing tools

Standards, guidelines, and criteria

Eg, ACOG Practice Bulletins

Eg, departmental screening tools

Developing tools

Provider buy-in essential Clinically important Guideline credibility Target audience Enlist physician champions make guidelines easy to follow quality vs. compliance measure improvement, share data update guidelines as needed

Implementation

Leadership Define future Align people with vision Inspire members to make change Confidentiality

Medical record review

Identify outliers Provider raised issues Clinical indicators Case referrals No deficiency Opportunity for improvement

Documentation Incomplete prenatal care Inappropriate care System deficiencies

CORRECTIVE

ACTION

Formulate plan Re: hospital/staff bylaws ?Legal counsel re: due process Education Surveillance Counseling External peer review Supervision of care Probation Restriction of privileges Dismissal from department

ACOG Screening Tools

Maternal mortality

Unplanned readmission within 14 days

Maternal cardiopulmonary arrest, resuscitated

In-hospital antibiotics >24 hrs after NSVD

Unplanned removal, injury, repair of organ during surgery

Excess maternal blood loss requiring intervention

ACOG Screening Tools

Eclampsia

Delivery unattended by the responsible provider

Death of infant >500 gm

Delivery at <32 weeks without NICU

Transfer of neonate to NICU

Cesarean delivery for failure to progress

ACOG Screening Tools

Cesarean delivery for non-reassuring fetal status

Post-term pregnancy

Repeat cesarean section

Concord Hospital Indicators

Unexpected mortality

Peri-operative mortality

Miscellaneous Occurrences Req. Peer Rev.

Deep incisional infection

Organ space infection

Superficial infection

Iatrogenic injury

Concord Hospital Indicators

Post-procedure hemorrhage

Post-partum hemorrhage

Apgar < 7 @ 5 minutes

Eclampsia

Birth trauma

4th Degree Perineal Laceration

What is the future?

Encourage Institutions to establish indicators

Encourage institutions to establish OB QA Committees

Encourage individuals and institutions to seek outside peer review as needed

NNEPQIN as PSO