Prospective evaluation of a continuous monitoring and quality-improvement system for reducing adverse neonatal outcomes.

Abstract

Our objective was to evaluate a prospective monitoring and quality improvement system for studying trends in the rates of an adverse neonatal outcome, the low Apgar scores (Apgar score <7). A cumulative sum (CUSUM) chart-based system was used to monitor the rate of low Apgar scores over 2 years. Root cause analysis (RCA) was used to investigate for causes of periods of increased low Apgar score rates. A period of deteriorated outcome (increased rates of low Apgar) occurred in August 2006. RCA identified deficiencies in cardiotocograph education, which were addressed by targeted training and mentoring. Prompt resolution followed, with the rates returning to baseline and staying within acceptable limits through to the end of evaluation in December 2007. Prospective and continuous monitoring of clinical outcomes using the CUSUM chart method is feasible and may be beneficial. Early detection of an adverse trend allows for timely corrective action, and may lead to overall improvements in performance.