Indicators for the Third and Fourth Degree Perineal Tears Clinical Care Standard

A set of indicators for the Third and Fourth Degree Perineal Tears Clinical Care Standard and their specifications is available, which can be used by clinicians and health services for local quality improvement purposes.

Indicator specifications

The Commission has developed a set of indicators to support clinicians and health services to monitor how well they are implementing the care described in this clinical care standard. Clinicians and health service organisations can use the indicators to support local quality improvement activities. No benchmarks are set for any indicator.

Detailed specifications for the indicators for the Third and Fourth Degree Perineal Tears Clinical Care Standard are available on the Metadata Online Registry (METeOR)  at

METeOR is an Australian web-based repository of nationally endorsed data and indicator definitions, hosted by the Australian Institute of Health and Welfare (AIHW).

Each indicator is described below and links to its specifications are provided.

Measuring and monitoring patient experience

Systematic, routine monitoring of patients’ experiences of, and outcomes from, health care is an important way to ensure that the patient’s perspective drives service improvements and patient-centred care. This is the case in all health services.

Patient experience measures

While this clinical care standard does not include indicators specific to measuring patient experiences, the Commission strongly encourages health services to use the Australian Hospital Patient Experience Question Set (AHPEQS). AHPEQS is a 12-question generic patient experience survey that has been validated in both day-only and admitted hospital patients across many clinical settings. The instrument is available for download to both private and public sector health services.

Patient-reported outcome measures

In Australia, patient-reported outcome measures (PROMs) are an emerging method of assessing the quality of health care. The Commission is leading a national work program to support the consistent and routine use of PROMs to drive quality improvement.

PROMs are standardised, validated questionnaires that patients complete, without any input from healthcare providers. They are often administered at least twice to an individual patient – at baseline and again after an intervention, or at regular intervals during a chronic illness. The information contributed by patients filling out PROMs questionnaires can be used to support and monitor the movement of health systems towards person-centred, value-based health care.

PROMs are being used to evaluate healthcare effectiveness at different levels of the health system, from the individual level to service and system levels. There is growing interest across Australia and internationally in the routine interrogation of patient-reported outcome information for evaluation and decision-making activities at levels of the health system beyond the clinical consultation.

Links with other quality initiatives

National Safety and Quality Health Service (NSQHS) Standards

Implementation of this standard is supported by the National Safety and Quality Health Service (NSQHS) Standards. Under the Clinical Governance Standard, health service organisations are expected to support clinicians to use the best available evidence, including clinical care standards (see Action 1.27b) and to monitor and respond to unwarranted clinical variation (Action 1.28).

Hospital-acquired complications

A hospital-acquired complication (HAC) is a complication for which clinical risk mitigation strategies may reduce (but not necessarily eliminate) the risk of that complication occurring. Third and fourth degree perineal laceration during delivery is listed as one of the nationally agreed HACs, for which data is routinely collected in all hospitals in Australia. It can be used in parallel with the recommended clinical care standard indicators to monitor the quality of care woman receive during childbirth.