Maternity Dashboard Research Articles

The maternity dashboard is an effective tool for the improvement of maternal and neonatal care outcomes: a prospective observational study from Iraq

Background: The implementation of maternal dashboards in hospitals is both feasible and effective in improving healthcare quality. The dashboards provide rapid feedback on local outcomes in an accessible format and enable early detection of potential problems. They serve as a simple computerized tool that graphically presents the health facility’s clinical data, utilizing a traffic-light coding system so as to alert front-line staff about changes in the frequency of clinical outcomes. Aim: The aim of this study was to assess the effectiveness of the maternity dashboard in improving maternal health, reducing Neonatal Intensive Care Unit (NICU) admissions, as well as enhancing maternal and neonatal outcomes in an Iraqi hospital. Methodology: Data were collected over one year, from January 1st to December 30th, 2023. A prospective observational study (hospital-based record review) was conducted at the Obstetrics and Gynaecology Teaching Hospital in Kerbala, Iraq. Data were obtained from the medical records of all patients admitted to the obstetrical ward for labor, delivery, and the postpartum period during 2023. The maternal dashboard, a traffic light program (green, amber, red), was used in order to monitor outcomes. Data were collected manually from the outpatient department, the labor ward, the NICU registers, and the electronic records by using Excel. Results: A total of 136,519 women (who were either pregnant, in labor, or postpartum for up to 42 days) were admitted to the Obstetrics and Gynaecology Teaching Hospital in Kerbala during the study period, with 18,791 of them delivering. The implementation of the maternity dashboard resulted in significant changes: the normal vaginal delivery rate increased from 66% to 68% (p=0.0024), the caesarean section rate decreased from 33% to 31% (p=0.0001), the stillbirth monthly cases declined from 16±5 to 12±3 (p<0.05), the NICU admission monthly instances decreased from 96±14 to 71±17 (p<0.05), and early neonatal death monthly cases were reduced from 12±5 to 9±3 (p<0.05). Conclusion: The study results show that maternity dashboards are vital instruments for monitoring and improving the quality of maternity care. They effectively enhance maternal and neonatal care quality indicators when comparing results before and after their implementation.

Identifying and Determining Effective Key Performance Indicators in the Development of Maternity Dashboard

Background: The well-being of both the mother and her baby can be influenced by the quality of the care they receive during pregnancy, childbirth, and postpartum. It’s crucial to ascertain the quality of the healthcare provided in order to improve it. Therefore, utilizing a maternity dashboard is vital to measure key performance indicators (KPIs), improve the quality of care, and ensure high-quality care. Objectives: To identify and determine effective KPIs for developing a maternity dashboard. Methods: This qualitative applied research was conducted in two stages to identify and determine KPIs for developing a maternity dashboard in Iran. In the first stage, a literature review was performed, followed by a qualitative comparative analysis of maternity dashboards in various countries to extract KPIs. In the second stage, 48 KPIs were identified and validated by a panel of experts using the Delphi technique. These KPIs were classified into 6 categories and finalized by the expert panel. Data analysis was conducted using content analysis and descriptive statistics. Results: In the initial phase of the Delphi technique, all experts confirmed three main categories of KPIs required for developing the maternity dashboard: (1) clinical activity, (2) fetal and neonatal complications, and (3) postnatal. In the second stage, an expert panel reviewed the indicators, leading to the identification of six groups of essential KPIs, including clinical activity, antenatal care, childbirth, maternal complications, fetal and neonatal complications, and postnatal care, upon which 100% consensus was reached by experts. Conclusions: Maternity dashboards are vital instruments for delivering effective maternity care. These dashboards can provide valuable and practical information through KPIs, which serve as criteria for evaluating performance.

Measure what you treasure! – A maternity dashboard

Background: Clinical quality dashboards equip hospitals with a simple method for maintaining and monitoring clinical quality indicators. The maternity dashboard. provides an opportunity to integrate managerial, organizational, and clinical audits to improve quality of care. It has four broad categories: clinical activity, workforce, clinical outcome, and complaints/risk incidents. It can be used to benchmark activity and monitor performance against the standards agreed locally for the maternity unit on a monthly basis. Aim: The aim of this study was to design and implement a maternity dashboard to improve maternal and child health care. Settings and Design: This was a retrospective observational study conducted at a tertiary care hospital. Materials and Methods: Data were collected manually from outpatient department, labor ward, neonatal intensive care unit registers, and electronic records from June 2018 to May 2019 in a tertiary care hospital. Goals for each of the parameters were set, as well as upper and lower thresholds, and the data were analyzed. A suggested approach is to use the traffic light system, such as “green,” “amber,” and “red.” All the parameters after analyzing were noted on the dashboard. Results: During the study period of 1 year, there were 3750 deliveries. Auditing was done for various clinical activity indicators along with clinical outcome (both maternal and neonatal) and triaged using traffic light colors on a monthly basis. Conclusions: Maternity dashboard facilitates targeted quality improvement initiatives. They help in comparing current performance against expected standards and hence helpful in driving changes toward optimum maternal and child health.

Development and Implementation of Maternity Dashboard in Regional Hospital for Quality Improvement at Ground Level: A Pilot Study.

ObjectivesWe sought to develop and implement a Maternity Dashboard to improve the quality of health care at the ground level.MethodsWe conducted a prospective, descriptive cross-sectional study, involving patients with high-risk pregnancies who had been referred to Nizwa Hospital, Oman. The selection of quality indicators was based on the prototype of clinical outcomes from the Royal College of Obstetricians and Gynecologists. The Maternity Dashboard team adapted local parameters and used preselected general parameters, based on clinical observations, to develop the dashboard.ResultsThe issues posing a threat to Nizwa Hospital in becoming a world-class healthcare facility were: overbooked outpatient department, insufficient staff, and more junior doctors compared to senior doctors and consultants. Additionally, being pioneers, naturally, the dashboard development team faced difficulties while handling adverse situations. More time, guidance, and standardization of quality indicators are desirable.ConclusionsFollowing the approval for a Maternity Dashboard in Nizwa Hospital, the data compiled in an Excel sheet are transmitted manually every month for display on the dashboard in the delivery suite. It is intended to make data collected and dissemination completely automated in the future with the help of the Al-Shifa Healthcare Information System. Expansion of the idea of a Maternity Dashboard to other hospitals and specialties at the regional and tertiary level of the health care system in Oman and a comparison of the standard of health care provided between hospitals based on similar quality indicators would be the next milestone.

The role of clinical dashboards in improving patient care: experience with the 'Maternity Dashboard'.

emergency caesarean sections or third degree perineal tears the clinical practice needs to be monitored to identify contributing factors such as errors in fetal monitoring or failed instrumental deliveries. This may help identify a ‘training issue’ with regard to instrumental vaginal births that could be easily rectified by conducting ‘one to one’ hands on training. Similarly, monitoring patient ‘complaints and compliments’ may identify areas in maternity service, which need to be improved. Once compliance with the ‘locally set’ standard has been achieved and monitored for some time, it may be removed from the Maternity Dashboard and new parameters may be considered for monitoring. It is important to use the Maternity Dashboard as a ‘dynamic’ clinical governance tool to monitor evolving risks and performance issues in a maternity unit. To ensure a systematic approach, individual parameters may be grouped under broad categories (e.g. ‘clinical activity’, ‘workforce’, ‘risk management’ and ‘responsive care’) on the Maternity Dashboard.

Onsite training of doctors, midwives and nurses in obstetric emergencies, Zimbabwe.

ProblemIn Zimbabwe, many health facilities are not able to manage serious obstetric complications. Staff most commonly identified inadequate training as the greatest barrier to preventing avoidable maternal deaths.ApproachWe established an onsite obstetric emergencies training programme for maternity staff in the Mpilo Central Hospital. We trained 12 local staff to become trainers and provided them with the equipment and resources needed for the course. The trainers held one-day courses for 299 staff at the hospital.Local settingMaternal mortality in Zimbabwe has increased from 555 to 960 per 100 000 pregnant women from 2006 to 2011 and 47% of the deaths are believed to be avoidable. Most obstetric emergencies trainings are held off-site, away from the clinical area, for a limited number of staff.Relevant changesFollowing an in-hospital train-the-trainers course, 90% (138/153) of maternity staff were trained locally within the first year, with 299 hospital staff trained to date. Local system changes included: the introduction of a labour ward board, emergency boxes, colour-coded early warning observation charts and a maternity dashboard. In this hospital, these changes have been associated with a 34% reduction in hospital maternal mortality from 67 maternal deaths per 9078 births (0.74%) in 2011 compared with 48 maternal deaths per 9884 births (0.49%) in 2014.Lessons learntIntroducing obstetric emergencies training and tools was feasible onsite, improved clinical practice, was sustained by local staff and associated with improved clinical outcomes. Further work to study the implementation and effect of this intervention at scale is required.

National survey of perineal trauma and its subsequent management in the United Kingdom.

Perineal trauma affects approximately 350,000 women per annum in the United Kingdom (UK) and is associated with considerable morbidity. Symptoms are most severe following obstetric anal sphincter injuries (OASIS) compared with other grades of perineal trauma. The Royal College of Obstetricians and Gynaecologists (RCOG) guidelines indicate that the rate of OASIS is 1 % of vaginal deliveries. In 2011, the RCOG implemented the "Maternity Dashboard" so that units could benchmark their performance against national standards of which OASIS is a component. Our primary objective was to establish the national rate of OASIS and audit variations in incidence and management of obstetric perineal trauma. We carried out a questionnaire-based survey auditing national practice. Every UK maternity unit was contacted regarding perineal outcomes after all deliveries between January 2009 and January 2010. 215 of the 265 units in the UK responded (81 %). 692,259 of the 790,197 deliveries in the UK for the same period were sampled (88 %). 75 % delivered vaginally. The median national OASIS rate was 2.85 % (0-8 %). 20.2 % of women delivering vaginally had episiotomies; none were midline. 12.4 % of second-degree tears were not repaired in low-risk units compared with 5.9 % in high-risk units. 57.1 % of units used the perineal trauma classification of the RCOG. This study provides comprehensive data regarding the incidence and management of perineal trauma across the UK. Clinicians and policy-makers, both local and at the RCOG, can devise up-to-date realistic guidelines on the anticipated rate of OASIS and help to assess the compliancy of units with guidelines on the appropriate management of perineal trauma.

Adaptation and implementation of local maternity dashboards in a Zimbabwean hospital to drive clinical improvement

The Commission on Information and Accountability for Women's and Children's Health of the World Health Organization (WHO) reported that national health outcome data were often of questionable quality and "not timely enough for practical use by health planners and administrators". Delayed reporting of poor-quality data limits the ability of front-line staff to identify problems rapidly and make improvements. Clinical "dashboards" based on locally available data offer a way of providing accurate and timely information. A dashboard is a simple computerized tool that presents a health facility's clinical data graphically using a traffic-light coding system to alert front-line staff about changes in the frequency of clinical outcomes. It provides rapid feedback on local outcomes in an accessible form and enables problems to be detected early. Until now, dashboards have been used only in high-resource settings. An overview maternity dashboard and a maternal mortality dashboard were designed for, and introduced at, a public hospital in Zimbabwe. A midwife at the hospital was trained to collect and input data monthly. Implementation of the maternity dashboards was feasible and 28months of clinical outcome data were summarized using common computer software. Presentation of these data to staff led to the rapid identification of adverse trends in outcomes and to suggestions for actions to improve health-care quality. Implementation of maternity dashboards was feasible in a low-resource setting and resulted in actions that improved health-care quality locally. Active participation of hospital management and midwifery staff was crucial to their success.

Introducing an acute gynaecology dashboard as a new clinical governance tool

Purpose – Risk management is an essential cornerstone of any effective unit. The maternity dashboard has been found to be an efficient governance tool, but there is no such scorecard in gynaecology. The paper aims to conceptualise and implement an acute gynaecology dashboard in a teaching hospital over a period of two years and review the changes brought in practice as a result of the dashboard.Design/methodology/approach – This acute gynaecology dashboard was designed in line with the existing maternity dashboard. Goals and benchmarks were determined on the basis of available national guidelines, expert opinions and local policies. The dashboard was prospectively implemented, updated monthly and presented in the relevant forums. A retrospective overview of the changes brought in the practice is presented in this paper.Findings – Through the use of the dashboard significant problems related to workforce, training and clinical activity were identified. A number of changes were subsequently executed to impr...

Development of maternity dashboards across a UK health region; current practice, continuing problems

ObjectiveTo assess the development of local clinical dashboards in line with UK national guidance and to identify ongoing issues being faced by maternity units, across an entire health region, in developing quality assurance systems. Study designA mixed-methods study involving all consultant-led maternity units in the South West of England Strategic Health Authority region (SWSHA). An electronic survey, followed by semi-structured interviews with the lead obstetrician and risk management midwife (or equivalent) of each maternity unit, to investigate methods employed to monitor outcomes locally, particularly the development of tools including maternity dashboards. Interviews were audio recorded, transcribed and thematically analysed to identify conceptual categories and themes. Results12/15 eligible consultant-led maternity units participated in the study and 10/12 (83%) of these used a dashboard. There was an excessive number of non-standard indicators used by the maternity units, with 352 different quality indicators (QIs), covering 37 different indicator categories, with up to 39 different definitions for one particular QI. Issues identified were: an excess of indicators, disproportionate time taken to produce the dashboard, uncertainty surrounding thresholds for alert within the dashboards and a desire for more guidance and standardisation of indicators, and their use. ConclusionsFollowing recommendation by the Royal College of Obstetricians and Gynaecologists, maternity dashboards have been widely adopted by maternity units across the SWSHA to provide a local quality assurance system. There is, however, wide variation in both the quality indicators monitored and their definition. There is an urgent requirement for a national and international core set of maternity QIs. Further guidance is also required to inform alert thresholds for adverse outcomes. These perinatal data are collected electronically, and automating the production of a standardised dashboard is both possible and desirable.

Intrapartum care quality indicators: a systematic approach for achieving consensus

To identify published maternity intrapartum quality indicators and rationalise them to a core set. Prospective qualitative consensus group exercise. A literature search identified sets of intrapartum quality indicators in the English language. These were rationalised to a shortlist using criteria adapted from 'The Good Clinical Indicator Guide'. An expert panel from key UK professions and organisations utilised a modified Delphi process to devise a final agreed set of intrapartum quality indicators that are specific, measurable, modifiable and relevant to clinical practice. Each indicator was rated in two rounds of web-based surveys, followed by a final face-to-face meeting of the panel. 290 clinical indicators were identified within 96 clinical categories with up to 18 different definitions. After rationalisation, 10 core and 24 additional quality indicators entered the Delphi process. A final panel of 12 indicators was defined. By using a simple Delphi process we have defined a set of broad clinical quality indicators that provide a comprehensive coverage of labour and delivery outcomes. We believe that this pragmatic portfolio will be useful for many wishing to develop performance monitoring and maternity dashboard systems.

The dash study: evaluation of maternity risk management team's views and use of maternity dashboards

AimTo assess current provision and implementation of maternity dashboards across the South West Strategic Health Authority (SW SHA)BackgroundReductions in preventable obstetric harm are a priority: 50% of maternal deaths and...

Protecting mothers and babies

IntroductionIn East Anglia 25% of babies are delivered by caesarean section (CS). Much work has focused on reduction of elective caesareans by vaginal birth after CS clinics and external cephalic...

Clinical dashboards: do they actually work in practice? Three-year experience with the Maternity Dashboard

Clinical governance refers to a system or a framework through which National Health Service (NHS) organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence will flourish. Various ‘dashboards’ or ‘score cards’ are currently being promoted with an intention of improving patient care and outcomes. It is believed that a closer observation of selected parameters, on a regular basis, may facilitate timely action, thereby avoiding adverse incidents. It is, therefore, hoped that such ‘dashboards’ or ‘score cards’ may also help clinicians, managers, trust boards, commissioners and patients to identify areas of good clinical practice and also to recognize areas that require improvement.

O164 The role of the ‘Maternity Dashboard’ in improving patient care: 2 year experience at a tertiary centre

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S139-S139 Free communication (oral) presentations O164 The role of the ‘Maternity Dashboard’ in improving patient care: 2 year experience at a tertiary centre E. Chandraharan, E. ChandraharanSearch for more papers by this authorJ. Sutton, J. SuttonSearch for more papers by this authorJ. Beattie, J. BeattieSearch for more papers by this authorS. Arulkumaran, S. ArulkumaranSearch for more papers by this author E. Chandraharan, E. ChandraharanSearch for more papers by this authorJ. Sutton, J. SuttonSearch for more papers by this authorJ. Beattie, J. BeattieSearch for more papers by this authorS. Arulkumaran, S. ArulkumaranSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)60536-1Citations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S139-S139 RelatedInformation

O865 Mat-dash: A statistically informed automated maternity dashboard tool

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S339-S339 Free communication (oral) presentations O865 Mat-dash: A statistically informed automated maternity dashboard tool T. Sibanda, T. SibandaSearch for more papers by this authorT. Draycott, T. DraycottSearch for more papers by this author T. Sibanda, T. SibandaSearch for more papers by this authorT. Draycott, T. DraycottSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)61238-8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S339-S339 RelatedInformation