Instances of IHS labor and delivery care not following national clinical guidelines or best practices
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Report in brief (United States. Department of Health and Human Services. Office of Inspector General)
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections. issuing body.
- Publication:
- Washington, D.C. : U.S. Department of Health and Human Services, Office of Inspector General, December 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Government Regulation Labor, Obstetric Parturition Standard of Care -- standards United States United States. Department of Health and Human Services United States. Indian Health Service
- Genre(s):
- Technical Report
- Abstract:
- Why OIG Did This Review. During a review of medical records for the Office of Inspector General (OIG) study Incidence of Adverse Events in Indian Health Service Hospitals (OEI-06-17-00530), our clinician-reviewers identified instances in which labor and delivery patients received care that did not follow national clinical guidelines or best practices. We conducted this companion study because most of these instances, although concerning, did not result in patient harm, and therefore do not appear in our main report about adverse events. Due to the small number of labor and delivery patients included in this review and our sample design, these instances are not projectable to all labor and delivery patients in Indian Health Service (IHS) hospitals. How OIG Did This Review. We reviewed medical records associated with 48 labor and delivery patients to identify instances in which providers did not follow national clinical guidelines or best practices. For each record, an obstetrics nurse and an obstetrician-gynecologist—each with specialized experience in patient safety— assessed whether the care met national clinical guidelines for diagnosing and treating postpartum hemorrhage, induction of labor, delivery via Caesarean section, and diagnosis and treatment of severe hypertension/preeclampsia. In addition, our reviewer examined whether the diagnosis of postpartum hemorrhage incorporated the best practice of quantitiative estimation of blood loss. We also asked IHS hospitals to describe training for providers of maternal care, and their implementation of the Alliance for Innovation on Maternal Health (AIM) “bundles” of maternal-safety best practices. What OIG Found. We found that 27 of 48 labor and Slightly more than half of the delivery patients (56 percent) had some 48 IHS labor and delivery aspect of care that did not follow patients in our sample received national clinical guidelines (13 patients), care that did not follow national did not use best practices for blood loss clinical guidelines or best estimation (8 patients), or included both practices. For about half of concerns (6 patients) during their stays these patients, providers did not at IHS hospitals. use the best practice of Postpartum hemorrhage is one of the quantitative estimation of blood most severe maternal health loss during a postpartum complications and is rare nationally, hemorrhage. affecting about 1 to 3 percent of deliveries. Among the 48 IHS labor and delivery patients in our sample, 16 patients (33 percent) experienced a postpartum hemorrhage. Most of these patients—14 of the 16—received care related to the hemorrhage that did not follow national clinical guidelines or best practices. For some patients, IHS hospital staff did not diagnose the hemorrhage in a timely manner, resulting in delays in treatment that could have reduced the excessive bleeding. Other instances of care included IHS providers not following national clinical guidelines when inducing labor. Of the 13 patients in our sample with induced labor, providers did not follow national clinical guidelines for 10 patients. Most of these cases were related to inappropriate doses of induction medication. IHS has also taken steps to directly address improvement in labor and delivery services via its ongoing implementation of maternal-safety best practice “bundles,” or sets of maternal-safety best practices, developed by AIM. Yet at the time of our review, 3 of the 10 IHS hospitals with labor and delivery units had yet to implement any of the AIM best practice bundles as requested by the IHS Chief Medical Officer.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (34 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918282678506676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918282678506676