Obstetrics – blood transfusion post-delivery rate
Metric
The proportion of mothers who received a blood transfusion post-delivery.
Numerator
Presence of any of the following OPCS Codes with a procedure date on or later than the delivery date: X331-X333, X339
Denominator
Any spell with a primary procedure of one of the following OPCS codes:
- R17 Elective caesarean delivery
- R18 Other caesarean delivery
- R19 Breech extraction delivery
- R20 Other breech delivery
- R21 Forceps cephalic delivery
- R22 Vacuum delivery
- R23 Cephalic vaginal delivery with abnormal presentation of head at delivery without instrument
- R24 Normal delivery
- R25 Other methods of delivery
Equivalent to “Delivery” procedure group in the DFI tools
Data Source
SUS – CDS
Time frame
April 2010 – March 2011
Basis
Acute trust
Statistical methods used
Crude rate
Notes
Query for the consultation: Are the OPCS codes for transfusion appropriate? What about blood transfusions with no date? Could perhaps be included with a change of definition (blood transfusion during spell in which delivery occurred).
CFH clinical coding manual Version 4.0
page X-13
Patients may recieve a blood transfusion (X33) during an epsiode of care for a number of reasons. often during major surgery, eg major bowel surgery, transplants, jopint replacements etc. Patients are routinely given blood transfusions of part of the surgery.
ONLY if the patient is admitted soley for the purpose of a transfusion of blood must the transfusion be coded.
This is the most useful measure for real post-partum haemorrhage and should be collected. Given that there are standard national guidelines on who to transfuse, the rates should correlate reasonably well with the rates of significant PPH.
If it is intended that a metric such as ‘rate of blood transfusion’ will be useful to compare the performance of maternity units, it will be meaningless unless casemix is taken into account. For example, if in a network of hospitals, one unit cares for all women with placenta accreta, the net effect will be to increase the blood Tx rate in that hospital, and decrease it in the others.
On the blood transfusion Not convinced that this is a good indicator to be using – I am assuming they are trying to identify those women with significant PPH’s problem with collecting data on Post birth blood transfusions . Whilst I think a good indicator – we do need to be measuring like for like – Some hospitals may have a different case mix, and take the higher risk cases and then they would stand out as a problem .
length of stay measure must exclude time in labour and time spent trying to induce women, therefore I take it that we should be looking at time from delivery to discharge on the Instrumentals, LSCS etc