Impact of a Labor and Delivery Safety Bundle on a Modified Adverse Outcomes Index

Abstract Background The obstetrics Adverse Outcomes Index was designed to measure the quality of perinatal care and includes ten adverse events that may occur at or around the time of delivery. We hypothesized that adverse outcomes on labor and delivery, including hypoxic ischemic encephalopathy, could be decreased with a combination of interventions, even among high-risk pregnancies. Objectives To evaluate the impact of a labor and delivery care bundle on adverse obstetrics outcomes as measured by a modified obstetrics Adverse Outcomes Index, Weighted Adverse Outcomes Index, and Severity Index. Study Design This is a retrospective cohort study including all women who delivered at our academic, tertiary care institution over a 3-year period of time, before and after implementation of an intervention to decrease adverse outcomes. Outcome measures consisted of previously reported indices that were modified including the addition of hypoxic ischemic encephalopathy. The Adverse Outcomes Index is a percentage of deliveries with one or more adverse events, the Weighted Adverse Outcomes Index is the sum of the points assigned to cases with adverse outcomes divided by the number of deliveries, and the Severity Index is the sum of the adverse outcome scores divided by the number of deliveries with an identified adverse outcome. Segmented regression analysis was utilized to evaluate differences in the level and trend of each index before and after our intervention using calendar month as the unit of analysis. Results During the study period, 5,826 deliveries met inclusion criteria. Comparing the pre- and post-intervention periods, high-risk pregnancy was more common in the post-intervention period (73.5% vs 79.4%, p