Feasibility of establishing a Canadian Obstetric Survey System (CanOSS) for severe maternal morbidity: results of a nationwide survey.
Malhamé I., Seymour RJ., Ashraf R., Gehrke P., Beyene J., Seedu T., Ahmed R., Dzakpasu S., Thorne S., Fell D., Metcalfe A., Chen KK., Lapinsky S., Skeith L., Murray-Davis B., Chundamala J., Hutchinson SA., Van den Akker T., Ospina MB., Shah PS., Joseph KS., Scott H., Barrett J., Cook J., Knight M., D'Souza R.
OBJECTIVE: Obtaining data on events, processes, and circumstances leading to severe maternal morbidity (SMM) could enable targeted interventions to improve care. We aimed to assess the feasibility of gathering such data from across Canada through an Obstetric Survey System (CanOSS). STUDY DESIGN: A nationwide survey. METHODS: We administered the electronic survey in French or English to birthing unit leads across all Canadian provinces and territories using REDCap. We presented pooled participation rates (95 % confidence intervals [CI]) across birthing units from lowest, medium, and highest tiers of service using Freeman-Tukey double arcsine transformations and common-effect models. RESULTS: Of the 289 birthing units across Canada, 167 (57.8 %) participated in the survey. Pooled participation rates per province and territory stratified by highest, medium, and lowest tiers of service were 91.5 % (95 % CI [73.4, 100]), 58.6 % (95 % CI [48.5, 68.6]), and 54.4 % (95 % CI [41.7, 66.3]), respectively. Units reported postpartum hemorrhage (82.5 %), hypertensive disorders (65.7 %), infections (35.0 %), venous thromboembolism (16.0 %), and maternal birth injuries (15.4 %) as the leading causes of SMM. Most birthing units (80.3 %) had a system in place for reviewing SMM events. Although most review systems involved multidisciplinary expert panels with representation from birthing unit leads (82.0 %), nursing (78.0 %), and obstetrics (73.7 %), specialties, such as obstetric anaesthesia (42.4 %), midwifery (41.5 %), and internal medicine (16.9 %), were underrepresented. Lessons learned were rarely shared outside the hospital and never shared beyond regional health authorities. Importantly, 76.2 % of respondents were willing to contribute anonymized SMM data within a centralized reporting system. CONCLUSIONS: Most responding Canadian birthing units have a process in place to review SMM and would be willing to share anonymized data as part of a centralized initiative, thereby demonstrating the feasibility of leveraging existing infrastructures to establish CanOSS.