A performance analytic application can help HCOs minimize childbirth-related complications and save lives.
A scathing USA TODAY investigation published recently indicated that thousands of women are injured or even die in childbirth each year. Risks include heavy bleeding, strokes due to untreated high blood pressure, paralysis, and fatal blood clots and infection.
It’s especially troubling that most other developed countries have much lower incident rates, and continue to improve. The data for the U.S. doesn’t just apply to small delivery centers, but also to major hospitals and large, state-of-the-art birthing centers all over the country.
Maternal injury and death are hard to keep track of because there’s no national system in place to track childbirth-related complications. Now, there is a growing call to standardize best practices and ensure compliance with treatment and prevention protocols in an effort to minimize risk.
Causes and Contributing Factors
Findings from the Report from Nine Maternal Mortality Review Committees, an initiative affiliated with the CDC Foundation, indicate that 63 percent of all pregnancy-related deaths in the U.S. could be prevented. Using mortality data from nine states, the report identified several causes that fall into two categories, direct and underlying. Direct causes included:
- Cardiovascular and coronary conditions
The underlying causes were:
- Mental health conditions
Among the factors contributing to pregnancy-related deaths were “patient and family factors, including lack of knowledge on warning signs and when to seek care,” as well as “provider factors, such as misdiagnosis and ineffective treatments, and system of care factors, such as poor coordination between providers.”
The Numbers Are Telling
USA TODAY’s investigation looked at more than 150 women and used information obtained from 75 birthing hospitals. The findings included:
- Each year, more than 50,000 women are severely injured during childbirth, and about 700 die. An estimated “half of these deaths could be prevented and half the injuries reduced or eliminated with better care.”
- Records show that in some hospitals fewer than 15 percent of mothers were promptly treated for dangerously high blood pressure that could result in a stroke.
- More than 40 percent of the maternity hospitals “acknowledged they were not quantifying blood loss after every birth — despite it being a cornerstone safety practice.”
Why Change Is Slow
Even if HCOs followed best safety practices, there’s no tracking system in place at the national level. Safety standards are not regulated when it comes to childbirth complications, so HCOs are not required to report internal failure to follow guidelines. Care failures also are too easy to mask by blaming patients, citing lack of prenatal care, or poor health and lifestyle choices.
A Gold Standard?
California is the one exception to the rising maternal death rate plaguing the rest of the U.S. HCOs there have implemented practices endorsed by medical societies that have cut California’s maternal death rate by half, including death from hemorrhage, heart attack, blood clots, and kidney failure.
To achieve these goals, hospitals in the state have been collecting maternal health data, drilling down on which complications might be prevented, determining evidence-based approaches to prevent complications, training care providers on treatment approaches, and monitoring compliance.
Monitoring care and adjusting treatment can reduce maternal death and injury. More HCOs are participating in voluntary childbirth safety improvement programs like the AIM Program, following California’s example. Under these programs, HCOs receive the life-saving toolkits and use so-called “safety bundles” containing childbirth safety checklists, procedures, and policies.
To deploy these established best practices, a hospital must improve tracking data, identify system issues, and monitor physician compliance. With our analysis tools that clean and integrate data from a variety of sources, d2i allows transparent monitoring of physicians and site compliance, and can help identify practice patterns and variations.