Conducting maternal mortality review in Affiliate hospitals: Challenges for the Regional Perinatal Center Team (RPC)

NYC Health and Hospitals Corporation (HHC), the largest public health care system in the country is continuously challenged to meet the Surgeon General's Healthy People 2010 goal of no more than 3.3 maternal deaths per 100,000 live births. Maternal deaths across the HHC hospitals decreased from thirteen in 2004 to six in 2007. The Corporation operates 11 acute care hospitals, six diagnostic and treatment centers (D&TC), four skilled nursing facilities, a certified home healthcare agency, over 80 community based clinics and a Managed Care agency. The patient population served is very diverse with many new immigrants. Prenatal care is provided at seventeen facilities across the City in the boroughs of Brooklyn, Bronx, Queens and Manhattan. Most pregnancies are considered high risk due to co-morbidities, social factors and late entry into prenatal care.

Two of the 11 HHC hospitals are designated as RPC, the highest designation for a perinatal center by NYS. The other nine HHC hospitals are affiliates of the two RPCs with seven designated as Level III and two as Level II. A major role of the RPC is to provide quality of care oversight to affiliate hospitals and implement quality improvement activities to improve perinatal outcomes. By utilizing the Root Cause Analysis process, the RPC team identified root causes for maternal deaths, recommended corrective actions for implementation and opportunities for improvement. This process of continuous monitoring and implementation of best practices have contributed to the decrease in maternal deaths.