Joint Commission to start reporting on high rate of C-sections, adds new standards

Earlier this year, The Joint Commission announced plans to begin reporting on hospitals with high rates of cesarean sections (C-sections) in July 2020. The high-rate designation will be based on hospitals’ rates on the perinatal care (PC) cesarean birth measure—PC-02—reported to The Joint Commission.

To improve the quality and safety of care provided to women during all stages of pregnancy and postpartum, The Joint Commission recently announced two new PC standards that are set to go into effect July 1, 2020, for all Joint Commission-accredited hospitals.

PC-02 measures the rates of cesarean births among a subset of the general obstetric population of low-risk women having their first birth with a term, singleton baby in a vertex position. The three criteria that will determine whether a hospital is identified as having a high rate will be based on data reported for 2018 and 2019, as follows:

  • 30 or more cases reported in both years
  • PC-02 rate of more than 30 percent for the current year
  • Overall two-year average PC-02 rate greater than 30 percent

Why were the new standards developed?

After the announcement, David Baker, MD, MPH, FACP, executive vice-president, Health Care Quality Evaluation, The Joint Commission, penned an article for The Joint Commission’s monthly blog Leading Hospital Improvement to provide answers to commonly asked questions, such as:*

  • Will overall cesarean rates ever be listed?
  • Is it possible to list all accredited hospitals for comparison purposes?
  • Will there be a way to account for differences in patient population, demographics, or medico-legal factors that may impact these rates?

In the blog, Dr. Baker also stated that The Joint Commission decided to move forward in reporting high C-section rates after making the following observations:*

  • Analysis determined C-section rates had not improved over the last several years
  • New evidence showed that hospitals can safely reduce their C-section rates without an increase in neonatal complications
  • The American College of Obstetrics and Gynecology provided new guidance on reducing C-section rates

What are the new standards?

The new standard on maternal hemorrhage will require organizations to complete an assessment using an evidence-based tool for determining risk upon admission to labor and delivery, as well as upon admission to postpartum care.

In addition, to improve the quality and safety of care provided to women during all stages of pregnancy and postpartum, The Joint Commission recently announced two new Provision of Care, Treatment, and Services (PC) standards that are set to take effect July 1, 2020, for all Joint Commission-accredited hospitals. They are as follows:

  • PC.06.01.01: Reduce the likelihood of harm related to maternal hemorrhage
  • PC.06.03.01: Reduce the likelihood of harm related to maternal severe hypertension/preeclampsia

The new standard on maternal hemorrhage will require organizations to complete an assessment using an evidence-based tool for determining risk upon admission to labor and delivery, as well as upon admission to postpartum care.

PC.06.01.01 also will require hospitals to develop written evidence-based procedures for stage-based management of pregnant and postpartum patients who experience maternal hemorrhage; the procedures  include the following:

  • Use of an evidence-based tool that includes an algorithm for identification and treatment of hemorrhage
  • Use of an evidence-based set of emergency response medications that are immediately available on the obstetric unit
  • Define required response team members and their roles in the event of severe hemorrhage
  • Define how the response team and procedures are activated
  • Provide a blood bank plan and response for emergency, as well as determine how to initiate the hospital’s massive transfusion procedures
  • Offer guidance on when to consult additional experts and consider transfer to a higher level of care
  • Suggest methods on how to communicate with patients and families during and after the event
  • Supply criteria for when a team debrief is required immediately after a case of severe hemorrhage

To learn more about the new PC requirements, view the prepublication standards on The Joint Commission’s website.

Disclaimer

The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.


*Baker D. Public reporting of high cesarean rates to begin in July 2020. In: Leading Hospital Improvement. The Joint Commission. Available at: www.jointcommission.org/the_view_from_the_joint_commission/public_reporting_of_high_cesarean_rates_to_begin_in_july_2020/. Accessed August 30, 2019.

Lyons M. New Joint Commission standards address rising maternal mortality in the U.S. The Joint Commission. Available at: www.jointcommission.org/new_joint_commission_standards_address_rising_maternal_mortality_/. Accessed August 30, 2019.

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