Using medico‐legal claims for quality improvement in maternity care: application and revision of an NHSLA coding taxonomy

Abstract

Objective To validate the NHSLA maternity claims taxonomy at the level of a single maternity service and assess its ability to direct quality improvement.Design Qualitative descriptive study.Setting Medico-legal claims between 1 January 2000 and 31 December 2016 from a maternity service in metropolitan Melbourne, Australia.Population All obstetric claims and incident notifications occurring within the date range were included for analysis.Methods De-identified claims and notifications data were derived from the files of the insurer of Victorian public health services. Data included claim date, incident date and summary, and claim cost. All reported issues were coded using the NHSLA taxonomy and the lead issue identified.Main outcome measures Rate of claims and notifications, relative frequency of issues, a revised taxonomy.Results A combined total of 265 claims and incidents were reported during the 6 years. Of these 59 were excluded, leaving 198 medico-legal events for analysis (1.66 events/1000 births). The costs for all claims was $46.7 million. The most common claim issues were related to management of labour (n = 63, $17.7 million), cardiotocographic interpretation (n = 43, $24.4 million), and stillbirth (n = 35, $656,750). The original NHSLA classification was not sufficiently detailed to inform care improvement programmes. A revised taxonomy and coding flowchart is presented.Conclusions Systematic analysis of obstetric medico-legal claims data can potentially be used to inform quality and safety improvement.

Improving the Quality of Maternity Care: Learning From Malpractice

“…The retrieved items should be filled in the information lists, including lawsuit number, province, geographic region, repeat defendant hospital, hospital level, liability degree of the hospital, closure year, length of the lawsuit (year), payment information, and injury outcomes. The causative domain was coded according to a revised version based on the NHSLA coding taxonomy 20 . In the original version of NHSLA coding taxonomy, 20 the “operative vaginal birth” domain contains 2 causative issues that “forceps or ventose delivery management” and “cesarean section management.” However, the “operative vaginal birth” was defined as a common procedure used to expedite birth after full cervical dilatation.…”

“…The causative domain was coded according to a revised version based on the NHSLA coding taxonomy 20 . In the original version of NHSLA coding taxonomy, 20 the “operative vaginal birth” domain contains 2 causative issues that “forceps or ventose delivery management” and “cesarean section management.” However, the “operative vaginal birth” was defined as a common procedure used to expedite birth after full cervical dilatation. Clinicians can access obstetrics forceps and vacuum instruments, which should be conducted with indication 21,22 .…”

“…In addition, most of the cause categories were based on the damage outcomes, which could not guide the quality improvement of maternity care. The National Health Service Litigation Authority (NHSLA) coding taxonomy was developed for maternity care based on the cause for obstetric medicolegal claims 20 . The NHSLA coding taxonomy was applied in the United Kingdom and the United States to direct the safety and service quality improvement for maternity care, which could guide the obstetrics providers pay more attention to prevent the risky cause.…”