title: Does a postpartum hemorrhage patient safety program result in sustained changes in management and outcomes?
abstract: 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.
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, IL. Electronic address: beinerso@gmail.com.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Einerson
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, IL.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Miller
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, IL.
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
mesh_terms: D000328:Adult; D016913:Blood Component Transfusion / Q000379:methods; D057189:Checklist; D015331:Cohort Studies; D061345:Early Medical Intervention / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007362:Intensive Care Units / Q000706:statistics & numerical data; D010120:Oxytocics / Q000627:therapeutic use*; D061214:Patient Safety; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D058996:Quality Improvement; D013536:Suture Techniques; D055357:Uterine Artery Embolization / Q000379:methods*; D058738:Uterine Balloon Tamponade / Q000379:methods*
chemical_list: D010120:Oxytocics
keywords: obstetrics; postpartum hemorrhage; protocols; quality improvement