Comparing Methods of Identifying Outlying Nurses in Audits of Low-Risk Cesarean Delivery Rates
| Autor: | Maureen E. Farrell, Stuart R. Lipsitz, Naomi Greene, Neel Shah, Kimberly D. Gregory, Samuel R. Woodbury, Joyce K. Edmonds, Amber Weiseth |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Quality management business.industry Cesarean Section Psychological intervention Nurse performance Audit Quality Improvement Decile Cohort Studies Pregnancy Emergency medicine medicine Humans Female Maternal Health Services Performance indicator Cesarean delivery business General Nursing Cohort study Retrospective Studies |
| Zdroj: | Journal of nursing care quality. 37(2) |
| ISSN: | 1550-5065 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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