Effective January 1, 2019, all hospitals that provide obstetric care and deliver at least 300 babies annually will be required to collect data for the newest Joint Commission Perinatal Core (PC) measure, called “PC-06 Unexpected Complications in Term Newborns.” This will be reported as the percentage of infants with unexpected newborn complications among full-term newborns with no preexisting conditions.

The goal of this measure is to gather more robust data on the approximately 90 percent of babies born who are term (defined as having reached 37 completed weeks gestation or more) and who are not expected to have any associated birth complications. We currently have outcomes in the preterm population, but lack information for this group.

It is important to note that PC-06 aims to collect data on those term infants who lack any complicating factors prior to delivery. Therefore, this PC does not include multiple gestations, fetuses with congenital anomalies or genetic diseases, babies born weighing less than 2,500 grams, in utero illicit drug exposure, out-of-hospital births, or certain pre-existing fetal conditions.

The level of complications tracked will be reported in an overall rate, but will also be subdivided into severe and moderate categories.

Severe complications include:

  • Death
  • Transfer to an acute care facility
  • Severe birth trauma
  • Asphyxia
  • Shock
  • Infection
  • Respiratory complications
  • Neurologic complications
  • Lengths of stay greater than 4 days with an ICD-10 code associated with sepsis

Moderate complications include:

  • Moderate birth trauma and respiratory complications
  • Lengths of stay greater than 2 days for a baby born vaginally or 4 days for a baby born via Cesarean section, along with any moderate birth trauma or respiratory or neurologic complications or infections
  • Lengths of stay greater than 5 days with no other associated ICD-10 codes, or with ICD-10 codes associated with jaundice or social indications

Complications that would fall in the severe category include intracranial hemorrhage or severe nerve injury, while moderate complications would include CPAP use, transient tachypnea of the newborn, or clavicular fracture sustained at the time of a shoulder dystocia.

As the reporting of these babies is based on ICD-10 codes, it will be important that each hospital has confidence in its coding for every associated newborn complication. It will likely be helpful as hospitals track their numbers that they review complication-specific codes to see where they can improve.

The goal of this measure is to serve a balancing measure; that is, while other measures report on the nulliparous term singleton Cesarean delivery (NTSV) rate, it is important at the same time to ensure that other complications are not rising in the term newborn population.

Data will be reported as an overall complication rate per 1,000 live births, which can then be further broken down into severe and moderate complication rates in the same populations.

It will be important that this measure be explained carefully to those team members who are involved in diagnosing and charting on these patients so that complications can be adequately tracked. It will also be important that obstetric providers understand the goal of this measure, and if any outliers are identified in terms of an abnormally high number of complications that the appropriate reviews and discussions be held. Midwives and maternal-fetal medicine physicians care for two very different obstetric populations, and they still may differ in the seemingly normal term labor and delivery. Therefore, it will be key that the appropriate infants are excluded from this group.

At the end of the day, this Perinatal Core measure’s goal is that the highest number of term newborns who are born at a hospital go home with their parents free of complications. This is an entirely reasonable expectation, and if collecting more robust data will help us increase those chances, we as healthcare providers should welcome it.

 
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References

  1. The Joint Commission. Specifications manual for Joint Commission National Quality Measures (v2018B).
  2. The Joint Commission Perspectives. Approved: New perinatal care performance measure.