title: Implementation of a multidisciplinary clinical pathway for the management of postpartum hemorrhage: a retrospective study.
abstract: OBJECTIVE
  To compare the outcomes of postpartum hemorrhage (PPH) episodes before and after the introduction of a clinical pathway known as the Severance Protocol to save postpartum bleeding through Expeditious care Delivery (SPEED).
  
  
  METHODS
  This study was designed as a retrospective analysis.
  
  
  METHODS
  The study was conducted in a hospital implementing SPEED.
  
  
  METHODS
  The non-SPEED group included 74 patients with PPH who were treated before the introduction of SPEED, whereas the SPEED group included 155 patients.
  
  
  METHODS
  Differences in outcomes were compared between groups.
  
  
  METHODS
  Reduction in treatment duration was the primary outcome measure, whereas uterus preservation was the secondary.
  
  
  RESULTS
  No significant intergroup differences were observed for hemoglobin levels, hematocrit values and vital signs upon patients' emergency room arrival. The turnaround time for hemoglobin, mean duration until treatment by obstetricians and gynecologists and duration between chest radiography ordering and performance significantly differed between the two groups (SPEED, 10.0 [1.0-30.0], 3.0 [0-25.0] and 23.0 [1.0-86.0] min, respectively; non-SPEED, 17.0 [1.0-37.0], 12.0 [0-62.0] and 46.0 [1.0-580.0] min, respectively; P < 0.001). Similarly, the mean duration until transfusion of cross-matched red blood cells (SPEED, 77.6 ± 58.6 min; non-SPEED, 103.4 ± 64.4 min; P = 0.015) and uterus preservation rate (SPEED, 90.1% [136/151]; non-SPEED, 81.7% [58/71]; P = 0.043) also differed significantly between the groups.
  
  
  CONCLUSIONS
  Clinical pathways enable prompt and efficient care for patients experiencing PPH through faster evaluation and access to red blood cell transfusion, resulting in a decrease in maternal mortality.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hee Young
authors.initials: HY
authors.lastname: Cho
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sungwon
authors.initials: S
authors.lastname: Na
authors.affiliation: Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Man Deuk
authors.initials: MD
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Incheol
authors.initials: I
authors.lastname: Park
authors.affiliation: Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyun Ok
authors.initials: HO
authors.lastname: Kim
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young-Han
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yong-Won
authors.initials: YW
authors.lastname: Park
authors.affiliation: Department of Quality Improvement, Severance Hospital, Seoul, Korea.
authors.forename: Ja Hae
authors.initials: JH
authors.lastname: Chun
authors.affiliation: Department of Quality Improvement, Severance Hospital, Seoul, Korea.
authors.forename: Seon Young
authors.initials: SY
authors.lastname: Jang
authors.affiliation: Department of Medical IT, Severance Hospital, Seoul, Korea.
authors.forename: Hye Kyung
authors.initials: HK
authors.lastname: Chung
authors.affiliation: Department of Obstetrics and Gynecology, Yonsei University, Wonju College of Medicine, Wonju, Gangwon, Korea.
authors.forename: Dawn
authors.initials: D
authors.lastname: Chung
authors.affiliation: Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Inkyung
authors.initials: I
authors.lastname: Jung
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ja-Young
authors.initials: JY
authors.lastname: Kwon
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008485:Medical Audit; D006473:Postpartum Hemorrhage / Q000628:therapy*; D012189:Retrospective Studies
keywords: SPEED; clinical pathway; postpartum hemorrhage