Improving quality of clinical coding of post-partum haemorrhage: the process and its effects on reported incidence rates in a New Zealand hospital maternity service
Geetha Galgali, Kim Fong, Karen Bissell, Delwyn Armstrong, Gayl Humphrey
The Waitemata District Health Board (DHB) improved the accuracy of post-partum haemorrhage (PPH) recording to understand its true incidence. PPH is leading cause of death among women giving birth worldwide and remains a risk in Western countries. Every inpatient discharged from a New Zealand public hospital has their doctor s notes read by clinical coders who translate the patient s diagnoses, complications, procedures and treatments into health codes according to an international classification system. This clinical coding process can miss complications such as PPH, if the doctor s documentation is incomplete or ambiguous. Therefore, the patients with PPH are undercounted. We investigated the incidence of PPH and concluded that the rate was under-reported. The Labour and Birth Summary Form was redesigned to include specific questions about the nature and treatment of PPH. Through a collaborative quality improvement project involving doctors, midwives and nurses, the form was redesigned, communicated to clinicians, checked for completion and returned if incomplete. This project changed behaviour and improved the use of preventative treatment for PPH. It improved accuracy of documentation and coding, and lifted the reported PPH rate from 4% to 12% within a year of project inception. The value of this increase is estimated at $544,000 based on the national price of inpatient stays. The approach of clinical leadership and engagement with clinical coding could benefit other services at Waitemata and other DHBs.
