Abstract
BackgroundThe lack of robust systems for monitoring quality in healthcare has been highlighted. Statistical process control (SPC) methods, utilizing the increasingly available routinely collected electronic patient records, could be used in creating surveillance systems that could lead to rapid detection of periods of deteriorating standards. We aimed to develop and test a CUmulative SUM (CUSUM) based surveillance system that could be used in continuous monitoring of clinical outcomes, using routinely collected data. The low Apgar score (5 minute Apgar score < 7) was used as an example outcome.MethodA surveillance system based on the Observed minus Expected (O-E) as well as the 2-sided Log-Likelihood CUSUM charts was developed. The Log-Likelihood chart was designed to detect a 50% rise (deterioration) and halving (improvement) in the odds of low Apgar scores. Baseline rates were calculated from data for 2001 to 2004, and were used to monitor deliveries for 2005. Deliveries for nulliparous and multiparous women were monitored separately. All analyses were retrospective.ResultsThe CUSUM system detected periods of increased rates of low Apgar scores for each of the nulliparous and multiparous cohorts. The overall rate for 2005 was eventually found to be 0.67%, which was higher than the baseline reference rate of 0.44% from 2001 to 2004.ConclusionCUSUM methods can be used in continuous monitoring of clinical outcomes using routinely collected data. Used prospectively, they could lead to the prompt detection of periods of suboptimal standards.
Highlights
The lack of robust systems for monitoring quality in healthcare has been highlighted
CUmulative SUM (CUSUM) methods can be used in continuous monitoring of clinical outcomes using routinely collected data
We describe the design and retrospective application of a surveillance system in the continuous monitoring of clinical outcomes using an Statistical process control (SPC) tool known as the CUmulative SUM (CUSUM) chart, using routinely collected data
Summary
The lack of robust systems for monitoring quality in healthcare has been highlighted. Statistical process control (SPC) methods, utilizing the increasingly available routinely collected electronic patient records, could be used in creating surveillance systems that could lead to rapid detection of periods of deteriorating standards. We aimed to develop and test a CUmulative SUM (CUSUM) based surveillance system that could be used in continuous monitoring of clinical outcomes, using routinely collected data. The low Apgar score (5 minute Apgar score < 7) was used as an example outcome. The increasing use of electronic patient records in healthcare presents an opportunity for the development and application of realtime monitoring systems that can lead to the rapid detection of adverse trends in healthcare. We describe the design and retrospective application of a surveillance system in the continuous monitoring of clinical outcomes using an SPC tool known as the CUmulative SUM (CUSUM) chart, using routinely collected data. We selected and used the "Observed minus Expected" (O-E) and the Log-likelihood CUSUM chart methods in designing our surveillance tool
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