Assessing Quality in Obstetrical Care: Development of Standardized Measures

Safety of labour and delivery following closures of obstetric services in small community hospitals

“…16,17 The index was created through an expert consensus process as a tool for assessing the safety of labour and delivery. It measures the occurrence of any of the following: maternal death, intrapartum stillbirth or in-hospital death of a newborn weighing more than 2500 g and having a gestational age of 37 weeks or greater with no congenital anomalies or fetal hydrops, uterine rupture, maternal admission to the intensive care unit, birth injury, unanticipated operative procedure, neonatal admission to the intensive care unit for a duration greater than 48 hours for newborns weighing more than 2500 g and having a gestational age of 37 weeks or greater, 5-minute Apgar score less than 7, maternal blood transfusion, or third-or fourth-degree perineal tear.…”

“…The weights account for the severity of different components in the composite (750 points for maternal death, 400 points for uterine rupture, 100 points for maternal admission to the intensive care unit, 65 points for birth trauma, 40 points for unanticipated operative procedure, 35 points for neonatal admission to the intensive care unit, 25 points for 5-minute Apgar score < 7, 20 points for blood transfusion, and 5 points for third-or fourth-degree tear). 16 We further examined an (equally weighted) secondary outcome consisting of the most serious components of the index: in-hospital maternal or perinatal death, uterine rupture or maternal admission to the intensive care unit. 19 Other secondary outcomes were as follows: maternal or newborn transfer to a secondary or tertiary care hospital, maternal admission-to-delivery interval (hours), mode of delivery (cesarean, instrumental delivery), use of obstetric interventions (epidural, labour induction, labour augmentation) and out-ofhospital birth (planned or unplanned).…”

Creating High Reliability Teams in Healthcare through In situ Simulation Training

“…A defensive barrier is a designed element of a system to prevent hazards from causing patient harm [29], and a breach as a gap in a defensive barrier that could lead to patient injury [42]. A breach is a failure of performance or of systems design that has the potential to lead to patient injury through the progression of accident trajectory [36].…”

“…A breach is a failure of performance or of systems design that has the potential to lead to patient injury through the progression of accident trajectory [36]. The Weighted Adverse Outcome Score (WAOS) is a metric that evaluates the effects of teamwork on obstetrical outcomes [42] The WAOS is constructed from a set of ten weighted adverse obstetrical outcome measures and is a summary indicator representing the average adverse event score per delivery [43]. The WAOS weighting system adjusts for the severity of adverse events, unlike other obstetrical outcome indicators [44].…”

Qualidade e segurança: caminhos para o sucesso do redesenho do modelo de cuidado obstétrico

“…Como indicador de resultado pode-se medir o impacto da conduta na redução da taxa de CS 5 . Alguns indicadores são sugeridos por órgãos internacionais e utilizados em estudos de grande impacto, tais como o Índice de Resultados Adversos, o Escore Ponderado de Resultados Adversos e o Índice de Gravidade 11,12 . Após a obtenção dos índices de qualidade e a definição das oportunidades de melhorias em um serviço, uma ampla investigação deve ser realizada para se identificar falhas no padrão de cuidados dentro da instituição, com foco no sistema, e não nos indivíduos.…”