1. PSI-17 Birth Trauma – Injury to the Neonate OB Adverse Event Affinity Call Lynne Hall 7/23/14

2.  What is an injury to the neonate?  Specifications of the PSI-17  Numerator/Denominator  What can be done?  Graph  Questions Framing

3.  Birth injury is defined as an impairment of the neonate's body function or structure due to an adverse event that occurred at birth.  Birth injury ranges from mild (bruising) to severe (death) Injury to the neonate

4. Risk Factors  Macrosomia  Maternal Obesity  Abnormal Fetal Presentation  Operative vaginal delivery  Cesarean Delivery Injury to the Neonate

5. Numerator:  To include only these codes: PSI-17 767 Birth trauma 767.0 Subdural and cerebral hemorrhage 767.1 Injuries to scalp due to birth trauma 767.11 Epicranial subaponeurotic hemorrhage (massive) 767.3 Other injuries to skeleton due to birth trauma 767.4 Injury to spine and spinal cord due to birth trauma 767.5 Facial nerve injury due to birth trauma 767.7 Other cranial and peripheral nerve injuries due to birth trauma 767.8 Other specified birth trauma

6.  Denominator:  Exclusions:  Preterm infants with a birth weight less than 2000 grams  Infants with any diagnosis code of injury to the brachial plexus  Infants with any diagnosis code of osteogenesis imperfecta  Cases with missing gender, age, quarter, year, or principal diagnosis  www.qualityindicators.ahrq.gov specifications manual www.qualityindicators.ahrq.gov PSI-17

7. What is NOT a birth trauma  Petechiae  Mongolian Spots  Hemangiomas  Port-wine Nevi  What else? PSI-17

8.  In CY2013 there were 152 incidents of Neonatal Injury  Ranges include 0 incidents to 28 incidents  Please email me if you would like your hospitals number of incidents: lhall@gha.orglhall@gha.org Neonatal Injury

9.  Review all cases that have been given the diagnosis of Neonatal Injury  Educate coders on what constitutes a birth injury  Example: Infant has petechiae (not a birth injury) – this gets coded as 767.8 Other birth injury  Encourage physicians to document clearly birth injuries  Example: instead of charting Mongolian spots chart normal finding of Mongolian spots What can be done?

10. PSI-17

11.  Has anyone reviewed cases and found errors?  What do you think can be done to lower the rate? Sharing

12.  Next meeting: August 27 th 11:00-11:30  No meeting in September Questions?