Monitoring healthcare quality in an obstetrics and gynaecology department using a CUSUM chart

OBJECTIVE

To use cumulative sum (CUSUM) charts for the early detection of variations in quality of care in a maternity department.

DESIGN

Retrospective analysis of prospectively collected data.

SETTING

Maternity department of a teaching hospital in Paris (France).

POPULATION

Data from 20 519 women and 21 448 infants were collected between January 2000 and December 2007.

METHODS

CUSUM charts were used to monitor the rate of 19 pre-selected quality indicators over 3 years (2005-2007), against standards developed by department obstetrician gynaecologists. Periods with adverse event rates that did not meet the standards were identified.

MAIN OUTCOME MEASURES

Quality indicator rates.

RESULTS

Indicators fell into three groups based on the number of periods with unacceptable rates: less than one per year [e.g. the rate of intensive care unit (ICU) admission of mothers and rate of third- or fourth-degree perineal tears]; one every 2-12 months on average (e.g. blood transfusion and sulprostone use in the overall population of women); and at least one per month (insufficient availability of epidural analgesia).

CONCLUSION

CUSUM charts for a broad range of quality indicators can be used to monitor the quality of care in an obstetrics department. A prospective study investigating the ability of CUSUM-based monitoring to improve maternal and neonatal outcomes would be of interest.