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Hospitals Urged to Track Quality in Obstetrics

Cheryl Clark, for HealthLeaders Media, February 2, 2012

Leapfrog is adding the measure because of "clear research that routine episiotomies do not help prevent more extensive vaginal tears during childbirth than natural tears, and that episiotomies can result in a variety of lasting morbidities for the mother (e.g., incontinence after childbirth, the mother’s bladder and rectum drooping into her vagina, pain during sex)," the group explains on its Website.

The incidence rate of episiotomies in vaginal births in 2008 and 2009 was slightly over 12%, but vary dramatically across providers and hospitals. It should be closer to zero, according to the National Perinatal Information Center/Quality Analytic Services database.

DVT prophylaxis, rates of which also vary widely, should be assured for women undergoing Cesarean section. Leapfrog adopted this measure in 2009 to encourage hospitals to strive to assure that at least 80% of patients receive this preventive care, such as fractionated or unfractionated heparin or pneumatic compression devices prior to surgery.

Jaundice and encephalopathy prevention should include routine bilirubin testing to prevent abnormal levels, and in extreme cases, a condition called Kernicterus.  Leapfrog wants hospitals to achieve testing rates of 80% or better.

"A fair number of Leapfrog participant hospitals meet the goals, but sometimes women leave the hospital early, and hospital providers say they should be responsible to watch out for symptoms on their own," Rudoph says. Under this measure, the hospital should make that monitoring routine.

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