title: Reducing the incidence of Obstetric Sphincter Injuries using a hands-on technique: an interventional quality improvement project.
abstract: A main concern for women giving birth is the risk of obstetric anal sphincter injuries. In our department the incidence of sphincter injuries was around 8 % among vaginally delivering first time mothers. We aimed to halve the incidence to 4 % or less. A prospective interventional program was instituted. We implemented a hands-on technique with four elements in a bundle of care together with a certification process for all staff on the delivery ward. The incidence of episiotomies served as a balancing indicator. The adherence to three of the four elements of the care bundle rose significantly while the all-or-nothing indicator leveled around 80 %. The median number of deliveries between cases with a sphincter injury increased from 9.5 in the baseline period to 20 during the intervention period. This corresponded with a reduction in the incidence from 7.0 % to 3.4 %. The rate of episiotomy remained low at 8.4 % in this group. By implementing the hands-on technique, we halved the risk of obstetric anal sphincter injuries. Our data suggest that further improvement may be anticipated. The study has demonstrated how implementation of a hands-on technique can be carried out within a quality improvement framework with rapid and sustainable results.
authors.affiliation: Department of Obstetrics and Gynaecology, Hospitalsenheden Vest, Herning, Denmark.
authors.forename: Ole Bredahl
authors.initials: OB
authors.lastname: Rasmussen
authors.affiliation: Department of Obstetrics and Gynaecology, Hospitalsenheden Vest, Herning, Denmark.
authors.forename: Annika
authors.initials: A
authors.lastname: Yding
authors.affiliation: Centre of Diagnostic Investigation, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Anh Ø
authors.affiliation: Department of Obstetrics and Gynaecology, Hospitalsenheden Vest, Herning, Denmark.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sander Andersen
authors.affiliation: Department of Obstetrics and Gynaecology, Hospitalsenheden Vest, Herning, Denmark.
authors.forename: Jane
authors.initials: J
authors.lastname: Boris