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

      Objective

      To determine whether the introduction of a postpartum hemorrhage (PPH) checklist and education program was associated with sustained changes in clinical practice and outcomes.

      Study Design

      This was a longitudinal cohort study of women with PPH at a single tertiary-care hospital from August 2007 to August 2011. In August 2008, a multidisciplinary PPH patient safety protocol was implemented which included 1) educational sessions regarding blood loss (EBL) estimation and 2) introduction of a checklist for PPH management. Clinical interventions as well as patient outcomes were abstracted from the medical record and compared across 6-month epochs using tests of trend.

      Results

      A total of 2751 women experienced PPH over the study period. Maternal characteristics that are known to be associated with the risk of PPH (i.e., multiple gestation, birth weight, placenta previa, chorioamnionitis, labor length, and rates of cesarean delivery) were similar during this period. After the introduction of the patient safety protocol, we observed a significant increase over time in the use of uterotonics and Bakri balloon placement (p<0.001 for each, Figure). Other PPH interventions including use of B-lynch suture, transfusion of packed red cells and fresh frozen plasma, use of uterine artery embolization, and postpartum hysterectomy did not change. Additionally, frequency of EBL >1500 mL was documented to increase (p=0.002) and rates of admission to the ICU decreased (p=0.021).

      Conclusion

      After the introduction of a multidisciplinary PPH program, we observed a sustained increase in the use of uterotonics and Bakri balloon placement. There was also a significant increase in the frequency of EBL >1500 mL after blood loss estimation training. These changes were associated with a concomitant decrease in frequency of ICU admissions.
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      Postpartum hemorrhage interventions and ICU admissions, in 6-month epochs