Developing key performance indicators using routinely collected healthcare data in obstetric patient blood management: A multi‐stage consensus study

BACKGROUND: Patient blood management (PBM) including appropriate red blood cell (RBC) transfusion underpins the management of severe anaemia and haemorrhage during pregnancy, delivery and postpartum. However, there is marked variation in practice despite guidelines and standards. Key performance indicators (KPIs) can identify deviation from agreed standards, support benchmarking and guide efforts to improve outcomes. We aimed to develop a set of obstetric PBM KPIs which may be measured from routinely collected electronic health records. METHODS: We undertook a three-stage process. First, we completed a scoping review to identify potential KPIs from relevant literature and clinical guidelines. Second, we conducted a modified RAND consensus process with a multidisciplinary panel of medical professionals. The consensus panel rated potential KPIs according to importance and feasibility. Third, our research team undertook a 'sense check' to refine and make the final selection of the KPIs. RESULTS: Out of 25 candidate KPIs initially identified, we derived a final set of 10 KPIs covering PBM in obstetrics and the RBC transfusion practice. Fifteen candidate KPIs were rejected: 6 KPIs were judged neither important nor feasible, 2 not feasible for further study at the current time, 2 not important to the general obstetric population and 5 represented organisation of care, rather than clinical practice. CONCLUSIONS: Using a systematic, stepwise, transparent approach, we have developed a set of 10 KPIs based on routine health data sources to monitor and guide improvement of PBM implementation, particularly RBC transfusion practice in obstetrics. These KPIs now require further field testing using routinely collected data.