Does a postpartum hemorrhage patient safety program result in sustained changes in management and outcomes?

We sought to determine whether the introduction of a postpartum hemorrhage (PPH) safety program was associated with changes in clinical practice and outcomes, and to examine whether these changes were sustained over time. In August 2008, a multidisciplinary PPH patient safety program was implemented...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2015-02, Vol.212 (2), p.140-144.e1
Main Authors: Einerson, Brett D., MD, MPH, Miller, Emily S., MD, MPH, Grobman, William A., MD, MBA
Format: Article
Language:English
Subjects:
Adult
Blood Component Transfusion - methods
Checklist
Cohort Studies
Early Medical Intervention - methods
Female
Humans
Hysterectomy
Intensive Care Units - utilization
obstetrics
Obstetrics and Gynecology
Oxytocics - therapeutic use
Patient Safety
postpartum hemorrhage
Postpartum Hemorrhage - diagnosis
Postpartum Hemorrhage - therapy
Pregnancy
protocols
Quality Improvement
Suture Techniques
Uterine Artery Embolization - methods
Uterine Balloon Tamponade - methods
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Summary:We sought to determine whether the introduction of a postpartum hemorrhage (PPH) safety program was associated with changes in clinical practice and outcomes, and to examine whether these changes were sustained over time. In August 2008, a multidisciplinary PPH patient safety program was implemented at our single tertiary care hospital. We performed a cohort study of all women with PPH from August 2007 through December 2011. Changes in clinical practice and outcomes were compared before and after the intervention. Shewhart charts were used to examine sustainability of these changes over time. During the study period 52,819 women delivered, and 3105 (5.9%) experienced PPH. After the introduction of the program there was a significant increase in the use of uterotonic medications ( P < .001), intrauterine balloon tamponade ( P  = .002), B-Lynch suture placement ( P  = .042), uterine artery embolization ( P  = .050), and cryoprecipitate use ( P  = .0222). Concomitantly, the number of days between admissions to the intensive care unit for PPH increased.
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2014.07.004