Comparing Methods of Identifying Outlying Nurses in Audits of Low-Risk Cesarean Delivery Rates. Issue 2 (24th April 2022)

• Record Type: Journal Article
• Authors: Edmonds, Joyce K.; Woodbury, Samuel R.; Lipsitz, Stuart R.; Weiseth, Amber; Farrell, Maureen E.; Shah, Neel T.; Greene, Naomi; Gregory, Kimberly D.
• Is Part Of: Journal of nursing care quality. Volume 37:Issue 2(2022)
• Page Start: 149
• Page End: 154
• Publication Date: 2022-04-24
• Subjects: audit and feedback -- benchmarking -- cesarean section -- nurses -- quality improvement -- risk adjustment; Nursing -- Standards -- Periodicals; Nursing audit -- Periodicals; Health facilities -- Safety measures -- Periodicals; Nurse administrators -- Periodicals; 610.73
• DOI: 10.1097/NCQ.0000000000000588
• Languages: English
• ISSNs: 1057-3631

Abstract

Abstract : Background: The low-risk cesarean delivery (CD) rate is an established performance indicator for providers in maternity care for quality improvement purposes. Purpose: Our objectives were to assess nurse performance using adjusted nurse-level CD rates and to compare methods of identifying nurse outliers. Methods: We conducted a retrospective, cohort study of 6970 births attended by 181 registered nurses in one hospital's maternity unit. Adjusted and unadjusted nurse-level CD rates were compared and agreement between 3 definitions (statistical, top decile, over a benchmark) of outliers calculated. Results: Adjusted nurse-level CD rates varied from 5.5% to 53.2%, and the unadjusted rates varied from 5% to 50%. Risk adjustment had little impact on the ranking of nurses, and outliers were consistently identified by 3 definitions. Conclusions: Trade-offs between statistical certainty and feasibility need to be considered when classifying nurse outliers. Findings can help target interventions to improve nurse performance.