Quality Assurance Practices in Obstetric Care

Abstract

Hospitals in California engage in a wide range of practices to assure or improve quality of obstetric care, but substantial variation in practice exists among hospitals. There is opportunity for improvement in adoption of evidence-supported practices.

Low‐Interventional Approaches to Intrapartum Care: Hospital Variation in Practice and Associated Factors

“…Characteristics of these hospitals were detailed elsewhere. 15 Overall, 89.7% of the 185 hospitals were in urban areas and 46.5% were teaching hospitals. Sixty-seven percent were private nonprofit hospitals, 13.5% were private for-profit hospitals, and 19.5% were government (nonfederal) hospitals.…”

“…Survey respondents were primarily directors of women's services, maternity care, or perinatal care (42.2%) or labor and delivery or perinatal nurse managers (29.4%); the remainder of survey respondent positions included but were not limited to labor and delivery or postpartum charge nurse, medical director, educator, and clinical nurse specialist. 15 Table 1 summarizes the 9 indicators of low-interventional practices for hospitals in the overall sample. Most hospitals always or frequently had an intravenous line placed for lowrisk, laboring women (94.1%) or used continuous electronic fetal monitoring during labor for low-risk women (85.3%), whereas only 9.7% of the hospitals always or frequently used intermittent auscultation for low-risk, laboring women who met eligibility criteria.…”

“…15 Nearly 40% of the respondents also reported incorporating input from other hospital colleagues when completing the survey. 15 Hence their reported data should reasonably reflect actual care at the hospital.…”

“…Nonetheless, survey respondents generally had long tenures in their institution and held positions warranting extensive knowledge about intrapartum care at their institution . Nearly 40% of the respondents also reported incorporating input from other hospital colleagues when completing the survey . Hence their reported data should reasonably reflect actual care at the hospital.…”

“…The primary data source was the California Hospital Survey of Maternity and Newborn Care conducted by our research team from 2015 to 2016. 15 This was a voluntary statewide survey of hospitals in California that provide labor and birth services, with an overarching aim to evaluate and better understand variation in the organization and delivery of maternity and newborn care across hospitals. The survey questions and process were developed based on an extensive literature search, focus group feedback, and pilot testing.…”