title: Severe postpartum haemorrhage after vaginal delivery: a statistical process control chart to report seven years of continuous quality improvement.
abstract: Severe postpartum haemorrhage after vaginal delivery: a statistical process control chart to report seven years of continuous quality improvement
  
  
  OBJECTIVE
  To use statistical process control charts to describe trends in the prevalence of severe postpartum haemorrhage after vaginal delivery. This assessment was performed 7 years after we initiated a continuous quality improvement programme that began with regular criteria-based audits
  
  
  METHODS
  Observational descriptive study, in a French maternity unit in the Rhône-Alpes region.
  
  
  METHODS
  Quarterly clinical audit meetings to analyse all cases of severe postpartum haemorrhage after vaginal delivery and provide feedback on quality of care with statistical process control tools.
  
  
  METHODS
  The primary outcomes were the prevalence of severe PPH after vaginal delivery and its quarterly monitoring with a control chart. The secondary outcomes included the global quality of care for women with severe postpartum haemorrhage, including the performance rate of each recommended procedure. Differences in these variables between 2005 and 2012 were tested.
  
  
  RESULTS
  From 2005 to 2012, the prevalence of severe postpartum haemorrhage declined significantly, from 1.2% to 0.6% of vaginal deliveries (p<0.001). Since 2010, the quarterly rate of severe PPH has not exceeded the upper control limits, that is, been out of statistical control. The proportion of cases that were managed consistently with the guidelines increased for all of their main components.
  
  
  CONCLUSIONS
  Implementation of continuous quality improvement efforts began seven years ago and used, among other tools, statistical process control charts. During this period, the prevalence of severe postpartum haemorrhage after vaginal delivery has been reduced by 50%.
authors.affiliation: Réseau périnatal Aurore - Hôpital de la Croix Rousse, Université Lyon 1, EAM 4128, laboratoire Santé, Individu, Société , faculté de médecine Laënnec, 69372 Lyon, France. Electronic address: Corinne.dupont@chu-lyon.fr.
authors.forename: Corinne
authors.initials: C
authors.lastname: Dupont
authors.affiliation: Hospices Civils de Lyon, Pôle Information médicale Evaluation et recherche; Université Lyon 1, Lyon, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Occelli
authors.affiliation: Inserm U953 Recherche épidémiologique en Santé périnatale Santé des femmes et des enfants, Paris.
authors.forename: Catherine
authors.initials: C
authors.lastname: Deneux-Tharaux
authors.affiliation: Hospices Civils de Lyon, Pôle Information médicale Evaluation et recherche; Université Lyon 1, Lyon, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Touzet
authors.affiliation: Hospices Civils de Lyon, Pôle Information médicale Evaluation et recherche; Université Lyon 1, Lyon, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Duclos
authors.affiliation: Inserm U953 Recherche épidémiologique en Santé périnatale Santé des femmes et des enfants, Paris.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Bouvier-Colle
authors.affiliation: Réseau périnatal Aurore - Hôpital de la Croix Rousse, Université Lyon 1, EAM 4128, laboratoire Santé, Individu, Société , faculté de médecine Laënnec, 69372 Lyon, France.
authors.forename: René-Charles
authors.initials: RC
authors.lastname: Rudigoz
authors.affiliation: Réseau périnatal Aurore - Hôpital de la Croix Rousse, Université Lyon 1, INSERM U846, Stem Cell and Brain Research Institute, Lyon, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Huissoud
mesh_terms: D000328:Adult; D054869:Clinical Audit / Q000379:methods; D036861:Delivery, Obstetric; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015995:Prevalence; D058996:Quality Improvement
keywords: Quality improvement programme; Severe postpartum haemorrhage; Statistical process control chart