title: From Postpartum Haemorrhage Guideline to Local Protocol: A Study of Protocol Quality.
abstract: Objective Postpartum hemorrhage (PPH) has a continuously rising incidence worldwide, suggesting suboptimal care. An important step in optimizing care is the translation of evidence-based guidelines into comprehensive hospital protocols. However, knowledge about the quality of these protocols is lacking. The objective of this study was to evaluate the quality of PPH-protocols on structure and content in the Netherlands. Methods We performed an observational multicenter study. Eighteen PPH-protocols from 3 University Hospitals (UH), 8 Teaching Hospitals (TH) and 7 Non-Teaching hospitals (NTH) throughout the Netherlands were acquired. The structure of the PPH-protocols was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) Instrument. The content was appraised using previously developed quality indicators, based on international guidelines and Advance-Trauma-Life-Support (ATLS)-based course instructions. Results The quality of the protocols for postpartum hemorrhage for both structure and content varied widely between different hospitals, but all of them showed room for improvement. The protocols scored mainly below average on the different items of the AGREE-II instrument (8 of the 10 items scored <4 on a 1-7 scale). Regarding the content, adoption of guideline recommendations in protocols was 46 %. In addition, a timely indication of 'when to perform' a recommendation was lacking in three-fourths of the items. Conclusion This study shows that the quality of the PPH-protocols for both structure and content in the Netherlands is suboptimal. This makes adherence to the guideline and ATLS-based course instructions difficult.
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Geert Grootplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. mallory.woiski@radboudumc.nl.
authors.forename: Mallory D
authors.identifier: 0000-0002-7553-5929
authors.initials: MD
authors.lastname: Woiski
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Geert Grootplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Helena C
authors.initials: HC
authors.lastname: van Vugt
authors.affiliation: Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, P.O. Box 5011, 2600 GA, Delft, The Netherlands.
authors.forename: Anneke
authors.initials: A
authors.lastname: Dijkman
authors.affiliation: Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Grol
authors.affiliation: Department of Anesthesiology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Abraham
authors.initials: A
authors.lastname: Marcus
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Middeldorp
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre (AMC), P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Ben W
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Geert Grootplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Femke
authors.initials: F
authors.lastname: Mols
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Oudijk
authors.affiliation: Department of Obstetrics and Gynaecology, Maxima Medical Centre, P.O. Box 90052, 5600 PD, Veldhoven, The Netherlands.
authors.forename: Martina
authors.initials: M
authors.lastname: Porath
authors.affiliation: Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Hubertina J
authors.initials: HJ
authors.lastname: Scheepers
authors.affiliation: Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Rosella P
authors.initials: RP
authors.lastname: Hermens
mesh_terms: D002985:Clinical Protocols; D036861:Delivery, Obstetric / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D019984:Quality Indicators, Health Care
keywords: Clinical protocols; Guideline adherence; Health care quality access and evaluation; Postpartum hemorrhage