Validation of anaemia, haemorrhage and blood disorder reporting in hospital data in New South Wales, Australia

Abstract Objective Hospital data are a useful resource for studying pregnancy complications, including bleeding-related conditions, however, the reliability of these data is unclear. This study aims to examine reliability of reporting of bleeding-related conditions, including anaemia, obstetric haemorrhage and blood disorders, and procedures, such as blood transfusion and hysterectomy, in coded hospital records compared with obstetric data from two large tertiary hospitals in New South Wales. Results There were 36,051 births between 2011 and 2015 included in the analysis. Anaemia and blood disorders were poorly reported in the hospital data, with sensitivity ranging from 2.5% to 24.8% (positive predictive value (PPV) 12.0–82.6%). Reporting of postpartum haemorrhage, transfusion and hysterectomy showed high sensitivity (82.8–96.0%, PPV 78.0–89.6%) while moderate consistency with the obstetric data was observed for other types of obstetric haemorrhage (sensitivity: 41.9–65.1%, PPV: 50.0–56.8%) and placental complications (sensitivity: 68.2–81.3%, PPV: 20.3–72.3%). Our findings suggest that hospital data may be a reliable source of information on postpartum haemorrhage, transfusion and hysterectomy. However, they highlight the need for caution for studies of anaemia and blood disorders, given high rates of uncoded and ‘false’ cases, and suggest that other sources of data should be sought where possible.

Download Full-text

637Validation of anaemia, haemorrhage and blood disorder reporting in routinely collected hospital data

International Journal of Epidemiology ◽

10.1093/ije/dyab168.054 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Heather Baldwin ◽

Siranda Torvaldsen ◽

Kristen Rickard ◽

Tanya Nippita ◽

Jillian Patterson

Keyword(s):

Postpartum Haemorrhage ◽

Hospital Data ◽

Blood Disorders ◽

Predictive Values ◽

Blood Disorder ◽

South Wales ◽

Obstetric Haemorrhage ◽

Reliable Source ◽

Tertiary Hospitals ◽

Hospital Administrative

Abstract Background Blood and bleeding related conditions are reported in hospital administrative data, however the reliability of these data is unknown. Here we examine the reliability of reporting of conditions including anaemia, obstetric haemorrhage and blood disorders, and procedures, such as transfusion and hysterectomy, in hospital records compared with obstetric databases. Methods Women giving birth to singleton infants in two tertiary hospitals in New South Wales, Australia, between 2011 and 2015 were included. Reporting in the hospital data, drawn from the Electronic Medical Records, was compared to that in linked obstetric data, obtained from the ObstetriX system, using obstetric data as the gold standard. Results 36,051 births were included. Sensitivity for anaemia and blood disorders was low (2.5–24.8%, positive predictive value (PPV) 12.0–82.6%), high for postpartum haemorrhage, transfusion and hysterectomy (82.8–96.0%, PPV 78.0–89.6%), and moderate for other obstetric haemorrhage (sensitivity: 41.9–65.1%, PPV: 50.0–56.8%) and placental complications (sensitivity 68.2–81.3%, PPV: 20.3–72.3%). Specificity and negative predictive values were high. Conclusions Anaemia and blood disorders are poorly reported in hospital data. Postpartum haemorrhage, transfusion and hysterectomy are well reported, while other obstetric haemorrhage and placental complications are moderately well reported. Key messages Hospital data may be a reliable source of information on postpartum haemorrhage, blood transfusion and hysterectomy. Caution is advised in the use of hospital data for studies of anaemia and blood disorders, and other sources should be sought where possible.

Download Full-text

Impact of the Four-Hour Rule policy on emergency medical services delays in Australian EDs: a longitudinal cohort study

Emergency Medicine Journal ◽

10.1136/emermed-2019-208958 ◽

2020 ◽

pp. emermed-2019-208958 ◽

Cited By ~ 1

Author(s):

Nicola Wing Young Man ◽

Roberto Forero ◽

Hanh Ngo ◽

David Mountain ◽

Gerard FitzGerald ◽

...

Keyword(s):

Emergency Medical Services ◽

New South ◽

New South Wales ◽

Interrupted Time Series ◽

Medical Services ◽

Hospital Data ◽

Emergency Medical ◽

South Wales ◽

Meta Regression Analysis ◽

The Impact

IntroductionDelayed handover of emergency medical services (EMS) patients to EDs is a major issue with hospital crowding considered a primary cause. We explore the impact of the 4-hour rule (the Policy) in Australia, focusing on ambulance and ED delays.MethodsEMS (ambulance), ED and hospital data of adult patients presenting to 14 EDs from 2002 to 2013 in three jurisdictions were linked. Interrupted time series ‘Before-and-After’ trend analysis was used for assessing the Policy’s impact. Random effects meta-regression analysis was examined for associations between ambulance delays and Policy-associated ED intake, throughput and output changes.ResultsBefore the Policy, the proportion of ED ambulances delayed increased between 1.1% and 1.7% per quarter across jurisdictions. After Policy introduction, Western Australia’s increasing trend continued but Queensland decreased by 5.1% per quarter. In New South Wales, ambulance delay decreased 7.1% in the first quarter after Policy introduction. ED intake (triage delay) improved only in New South Wales and Queensland. Each 1% ambulance delay reduction was significantly associated with a 0.91% reduction in triage delay (p=0.014) but not ED length of stay ≤4 hours (p=0.307) or access-block/boarding (p=0.605) suggesting only partial improvement in ambulance delay overall.ConclusionThe Policy was associated with reduced ambulance delays over time in Queensland and only the immediate period in New South Wales. Associations may be due to local jurisdictional initiatives to improve ambulance performance. Strategies to alleviate ambulance delay may need to focus on the ED intake component. These should be re-examined with longer periods of post-Policy data.

Download Full-text