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Am J Perinatol
DOI: 10.1055/a-2282-8923
Original Article

Use of Postpartum Hemorrhage Checklist during Vaginal Deliveries: A Quality Improvement Study

Katharine E. Bruce 
1   Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
,
Shivani Desai
2   Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
,
Kelly Reilly
3   Institute for Healthcare Quality Improvement, University of North Carolina Health, Chapel Hill, NC
,
Arianna Keil
3   Institute for Healthcare Quality Improvement, University of North Carolina Health, Chapel Hill, NC
,
Michelle Swanson
4   Department of Women's Services, University of North Carolina Health, Chapel Hill, NC
,
Benjamin Cobb
5   Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC
,
Katelin Zahn
2   Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
,
Christine McKenzie 
5   Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC
,
Elizabeth Coviello
2   Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
,
Divya Mallampati
6   Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA
,
Kristin P. Tully
2   Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
,
Lavinia Kolarczyk
5   Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC
,
Shannon Maaske
2   Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
,
Johanna Quist-Nelson
2   Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
› Author Affiliations Funding None.
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Abstract

Objective Postpartum hemorrhage (PPH) protocols improve patient safety and reduce utilization of blood products; however, few data exist on sustainability of PPH checklist use, how use affects care delivery, and variation of use among patient subgroups. This study aimed to (1) examine compliance with PPH checklist use during vaginal deliveries, (2) evaluate whether checklist use varied by patient and/or care team characteristics, and (3) evaluate whether checklist use was associated with increased use of recommended medications/interventions.

Study Design This was a quality improvement study performed from April 2021 through June 2023. A multidisciplinary team developed a revised PPH checklist and used quality improvement methodology to increase checklist use following vaginal birth. Data were collected from medical records and clinician survey. Control charts were generated to track checklist use and evaluate special cause variation. Chi-square tests and logistic regression were used to evaluate variation in medications/interventions and across subgroups.

Results During the study period, there were 342 cases of PPH at the time of vaginal birth. The checklist was used in 67% of PPH cases during the 20-month period after implementation in a setting where no checklist was previously being used. We found no statistically significant differences in checklist use by patient or health care team characteristics. Use of tranexamic acid, carboprost, and misoprostol were significantly associated with checklist use.

Conclusion This study demonstrated successful implementation of a checklist protocol where no checklist was previously being used, with sustained use in an average of 67% of PPH cases over 20 months. Checklist use was consistent across subgroups and was associated with higher use of interventions shown to lower blood loss.

Key Points

  • Our study showed sustainability of PPH checklist use over a 20-month period.

  • PPH checklist use was associated with increased use of interventions known to reduce blood loss.

  • Checklist was used consistently across patient subgroups; may help address inequities in obstetric outcomes.

Keywords

health care quality improvement - obstetrics and gynecology - patient safety - checklists - postpartum hemorrhage

Note

Findings were presented at the Society for Maternal-Fetal Medicine, February 6 to 11, 2023, in San Francisco, CA.


Ethical Approval

This study was approved by the (Anonymized University) Biomedical Institutional Review Board (IRB # 21-2688).


Supplementary Material



Publication History

Received: 02 November 2023

Accepted: 05 March 2024

Accepted Manuscript online:
07 March 2024

Article published online:
30 March 2024

© 2024. Thieme. All rights reserved.

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