The activity
Recently, the local paper did an article on the nation's high rate of cesarean section deliveries.
The journalist featured interviews with Shoreline Birth Center doctors and patients who either
perform or had undergone cesarean sections. The Birth Center felt that the press would
negatively impact their bottom line and were hopeful that an analysis of birth data would show
Shoreline does not perform more cesarean section deliveries than the national average.
However, Shoreline’s birth data revealed a cesarean section rate of 34%, 1.9% higher than the
national average of 32.1%. The medical director believes that the Birth Center has a higher
cesarean section rate because they are the area’s only high-risk birth center. Being a high-risk
birth center means that Shoreline receives a higher percentage of high-risk births. She believes
that Shoreline’s high rate of cesarean section is related to the high-risk births and that cesarean
section results in a safer birth experience for these families. Shoreline's Public Relations officer is
happy to hear that Shoreline's high rate of cesarean may be related to a high rate of high-risk
patients, but she feels the public also needs to know that Shoreline is the safest place to give
birth. She would like to know the Perioperative mortality rate (POMR) at Shoreline.
You have been asked to research this issue and present your findings to the Shoreline Board.
Questions
1. What is POMR?
POMR is perioperative mortality rate. POMR is deaths that happen during or after
surgery. This includes deaths that occur on the same day as the operation/procedure
(even in the operating room) as well as those that happen before the patient leaves the
hospital or within 30 days of surgery, whichever comes first.
2. How is POMR measured?
POMR is measured by looking at the number of patients who die during or
shortly after surgery and diving it by the total number of surgical procedures
performed.
3. How is the POMR rate expressed?
POMR is expressed as a ratio or percentage. It is calculated by taking the
number of deaths during surgery, divided by the total number of
procedures performed. Example: total number of procedures – 500, total
number of deaths – 4
(4 deaths / 500 procedures) x 100 = 0.008 or 0.8%
4. What is the median POMR for cesarean section in low- to middle-
income countries? Refer to the table on page 5 of the Perioperative
, mortality rate meta-analysis resource that accompanied this activity
document under 1: Overview and Resources.
The median POMR for cesarean section in low- to middle-income
countries is 0.12%.
5. If high-income counties reported lower POMR rates than low-to-middle
income countries, what do you think could account for the different
POMR rates?
High-income countries reported lower POMR rates than low-to-middle
income countries because high-income countries have safer surgeries and
anesthesia is affordable. Those who live in high-income countries have
access to better healthcare than those who live in low-to-middle income
countries.
6. Why is POMR measurement important?
POMR measurement is important because it shows how safe and
effective surgical care is, and it helps hospitals identify which areas need
improvements and create ways to decrease/reduce deaths that are related
to surgeries.
7. What are some of the challenges in getting an accurate POMR around
the world?
One of the challenges in getting an accurate POMR around the world is
that the data can be hard to understand. Different countries have different
definitions of POMR or include different types of surgeries. Therefore, it is
hard to compare performance and know if one country is doing better or
worse than another.
Review the de-identified EHR that accompanies this activity under 2:
Launch EHR and answer the following questions.
8. Would this case be counted in Shoreline’s POMR? Why or why not?
Yes. This case would be counted in Shoreline’s POMR because the
patient died before she was discharged.
9. What procedure did this patient have?
The patient had a c-section with a live birth.
10. What is the ICD-10 code R99?
ICD-10 code R99 means that the cause of death was ill-defined and
unknown.
Recently, the local paper did an article on the nation's high rate of cesarean section deliveries.
The journalist featured interviews with Shoreline Birth Center doctors and patients who either
perform or had undergone cesarean sections. The Birth Center felt that the press would
negatively impact their bottom line and were hopeful that an analysis of birth data would show
Shoreline does not perform more cesarean section deliveries than the national average.
However, Shoreline’s birth data revealed a cesarean section rate of 34%, 1.9% higher than the
national average of 32.1%. The medical director believes that the Birth Center has a higher
cesarean section rate because they are the area’s only high-risk birth center. Being a high-risk
birth center means that Shoreline receives a higher percentage of high-risk births. She believes
that Shoreline’s high rate of cesarean section is related to the high-risk births and that cesarean
section results in a safer birth experience for these families. Shoreline's Public Relations officer is
happy to hear that Shoreline's high rate of cesarean may be related to a high rate of high-risk
patients, but she feels the public also needs to know that Shoreline is the safest place to give
birth. She would like to know the Perioperative mortality rate (POMR) at Shoreline.
You have been asked to research this issue and present your findings to the Shoreline Board.
Questions
1. What is POMR?
POMR is perioperative mortality rate. POMR is deaths that happen during or after
surgery. This includes deaths that occur on the same day as the operation/procedure
(even in the operating room) as well as those that happen before the patient leaves the
hospital or within 30 days of surgery, whichever comes first.
2. How is POMR measured?
POMR is measured by looking at the number of patients who die during or
shortly after surgery and diving it by the total number of surgical procedures
performed.
3. How is the POMR rate expressed?
POMR is expressed as a ratio or percentage. It is calculated by taking the
number of deaths during surgery, divided by the total number of
procedures performed. Example: total number of procedures – 500, total
number of deaths – 4
(4 deaths / 500 procedures) x 100 = 0.008 or 0.8%
4. What is the median POMR for cesarean section in low- to middle-
income countries? Refer to the table on page 5 of the Perioperative
, mortality rate meta-analysis resource that accompanied this activity
document under 1: Overview and Resources.
The median POMR for cesarean section in low- to middle-income
countries is 0.12%.
5. If high-income counties reported lower POMR rates than low-to-middle
income countries, what do you think could account for the different
POMR rates?
High-income countries reported lower POMR rates than low-to-middle
income countries because high-income countries have safer surgeries and
anesthesia is affordable. Those who live in high-income countries have
access to better healthcare than those who live in low-to-middle income
countries.
6. Why is POMR measurement important?
POMR measurement is important because it shows how safe and
effective surgical care is, and it helps hospitals identify which areas need
improvements and create ways to decrease/reduce deaths that are related
to surgeries.
7. What are some of the challenges in getting an accurate POMR around
the world?
One of the challenges in getting an accurate POMR around the world is
that the data can be hard to understand. Different countries have different
definitions of POMR or include different types of surgeries. Therefore, it is
hard to compare performance and know if one country is doing better or
worse than another.
Review the de-identified EHR that accompanies this activity under 2:
Launch EHR and answer the following questions.
8. Would this case be counted in Shoreline’s POMR? Why or why not?
Yes. This case would be counted in Shoreline’s POMR because the
patient died before she was discharged.
9. What procedure did this patient have?
The patient had a c-section with a live birth.
10. What is the ICD-10 code R99?
ICD-10 code R99 means that the cause of death was ill-defined and
unknown.
