Epidemiology

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

  1. R Boulkedid1,2,
  2. O Sibony3,4,
  3. C Bossu-Salvador3,
  4. JF Oury3,4,
  5. C Alberti1,2,4

Article first published online: 18 JUN 2010

DOI: 10.1111/j.1471-0528.2010.02632.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 117, Issue 10, pages 1225–1235, September 2010

Additional Information

How to Cite

Boulkedid, R., Sibony, O., Bossu-Salvador, C., Oury, J. and Alberti, C. (2010), Monitoring healthcare quality in an obstetrics and gynaecology department using a CUSUM chart. BJOG: An International Journal of Obstetrics & Gynaecology, 117: 1225–1235. doi: 10.1111/j.1471-0528.2010.02632.x

Author Information

  1. 1

    AP-HP, Hôpital Robert Debré, Unité d’Epidémiologie Clinique, Paris, France

  2. 2

    Inserm, CIE 5, Paris, France

  3. 3

    AP-HP, Hôpital Robert Debré, Pôle Gynécologie et Perinatalite, Hospitalisation Gynécologie–Obstétrique, Paris, France

  4. 4

    Université Paris 7 Denis Diderot, UFR de Médecine, Paris, France

*R Boulkedid, Unité d’Epidémiologie Clinique, INSERM CIE 5, Hôpital Robert Debré, 48 Bd Sérurier, 75019 Paris, France. Email rym.boulkedid@rdb.aphp.fr

Publication History

  1. Issue published online: 16 AUG 2010
  2. Article first published online: 18 JUN 2010
  3. Accepted 4 May 2010. Published Online 18 June 2010.

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Keywords:

  • CUSUM;
  • obstetrics;
  • quality indicators

Please cite this paper as: Boulkedid R, Sibony O, Bossu-Salvador C, Oury J, Alberti C. Monitoring healthcare quality in an obstetrics and gynaecology department using a CUSUM chart. BJOG 2010;117:1225–1235.

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.

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