title: Debriefing as a strategic tool for performance improvement.
abstract: In 2009, two large, West Coast perinatal units began a performance improvement project for obstetric hemorrhage. In this article we discuss the use of structured team debriefings for obstetric hemorrhage cases to measure performance improvement. Lessons learned from debriefings can be vital in gauging if recommended interventions are effectively embedded into clinical practice. Improved outcomes for the project included a 33% decrease in massive transfusions and a 78% decrease in unplanned hysterectomies for one medical center.
authors.affiliation: Kaiser Permanente NCAL Regional Risk Management, 1950 Franklin St, Oakland, CA 94612, USA. Nancy.Corbett@kp.org
authors.forename: Nancy
authors.initials: N
authors.lastname: Corbett
authors.forename: Patricia
authors.initials: P
authors.lastname: Hurko
authors.forename: John T
authors.initials: JT
authors.lastname: Vallee
mesh_terms: D002140:California; D005260:Female; D006801:Humans; D019982:Organizational Case Studies; D010348:Patient Care Team; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D058996:Quality Improvement; D012308:Risk Management / Q000379:methods*; D013647:Task Performance and Analysis