October 12, 2018

Congress seeks answers from 900 hospitals about maternal mortality

Daily Briefing

    Read Advisory Board's take: 5 questions executives should ask themselves in response to this investigation.

    House Ways and Means Committee on Wednesday launched an investigation into U.S. maternal mortality rates, asking operators of hundreds of U.S. maternity hospitals what they are doing to identify women with high-risk pregnancies.

    While most deliveries in the United States happen without incident, USA Today reports more than 50,000 U.S. women are severely injured and about 700 U.S. women die during childbirth annually. Research has shown African American women are three to four times more likely to suffer maternal complications or death. According to USA Today, "[t]he best estimates" suggest half of the severe injuries in the United States could be mitigated or eliminated and half of such deaths could be prevented "with better care."

    In July, USA Today said its investigation "reveal[ed] a stunning lack of attention to safety recommendations and widespread failure to protect new mothers." The investigation revealed doctors and nurses at some hospitals were not completing "basic tasks"—such as tracking blood loss by weighing bloody pads, or giving women blood pressure medications within an hour of detecting high blood pressure levels to prevent strokes—that experts recommend to keep women safe during childbirth.

    According to USA Today, this "lack of attention" occurred across hospital demographics, inside doctors' offices, at small community hospitals, and at large hospitals with the latest technology and training.

    House committee launches investigation

    The House Ways and Means Committee said it has sent letters 15 of the largest U.S. health systems, which combined operate more than 900 hospitals and delivered more than one in five babies in 2015.

    According to USA Today, the committee members selected the largest hospitals by patient revenues in 2015. Selected hospitals were not targeted because of potential mistakes in maternal care.

    The committee's letter asks hospitals by Nov. 15 to detail:

    • Processes for identifying women who are at risk of childbirth complications;
    • Tracking and documentation processes for reviewing pregnancy-related deaths and severe complications; and
    • Level of participation in programs that seek to standardize and improve childbirth safety practices.

    In addition, the committee requested information about each health system's birthing hospitals, including the number of babies delivered in 2017, as well as the number and causes of pregnancy-related deaths and severe complications for 2017 broken down by race.

    In a statement, committee GOP leaders said, "It is absolutely unacceptable that preventable failures are the cause of avoidable, unnecessary, and absolutely tragic deaths," adding, "With this investigation, we are committed to finding out why these deaths are happening and where Congress can take action to not only prevent these deaths, but also reverse this trend" (Young, USA Today, 10/10; Diamond, "Pulse," Politico, 10/10).

    Advisory Board's take

    Amanda Berra, Senior Research Partner

    This inquiry by Congress in reaction to the investigation by USA Today has made clear that shortfalls in maternal safety will not be forgotten any time soon. These investigations have illuminated maternal safety in a way that will prompt many hospital executives and board members to pick up the phone and start asking questions about the state of quality and safety at their organizations.

    They will likely ask several questions, including:

    1. "How could a blind spot like this happen?";
    2. "What have we been paying attention to, if not this?";
    3. "As an executive or board member, what questions should I be asking?";
    4. "What contributions are appropriate for executives/board on this issue?"; and
    5. "Should I be worries about data on our maternal safety shortfalls getting out?"

    For answers to these questions, and more, I suggest that you read the blog post I wrote in response to the initial expose.

    Blog Post: Our answers to the 5 top questions executives should ask themselves

    Then, I suggest you download our perinatal safety toolkit, which we've opened to all members in response to this story. In it, you can learn five strategies for identifying perinatal patient safety problems, download a ready-to-use presentation for making the case for investing in perinatal patient safety, learn how to create a perinatal safety committee and discover how other organizations have built a process for standardizing care protocols.

    Download Now


    Oct. 24 webcon: How Mission Health partnered with clinicians to standardize Cesarean sections

    Join leaders from Mission Health to learn how they reduced care variation for Cesarean sections—and improved both costs and quality outcomes in the process.

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