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

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Abstract

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.