(774) Increasing postpartum hemorrhage checklist use: A quality improvement initiative

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: National organizations recommend the use of a postpartum hemorrhage (PPH) checklist. Rates of clinical PPH checklist use have not been reported. The objective was to increase the rate of PPH checklist use from 0% to 75% during vaginal deliveries complicated by PPH through quality improvement (QI) measures.

Study Design: Prospective QI study measuring PPH checklist use during vaginal delivery at a tertiary care facility. We conducted pre-intervention assessment of PPH checklist use in vaginal deliveries with > 3 units packed red blood cell transfusion by a multidisciplinary review committee. Despite a PPH checklist being available, it was rarely used. Input from those cases prompted updates to the PPH checklist. Using QI methodology, we re-introduced the PPH checklist in an updated format throughout labor and delivery, postpartum and antepartum floors. Starting November 2021, all vaginal deliveries complicated by PPH (quantitative blood loss >1000 mL) were queried weekly for use of PPH checklist by surveys sent to a delivering team member. Delivery team members included nursing staff and delivery attendants. When surveys were not returned, the case was recorded as PPH checklist not used. Data regarding PPH checklist use, patient demographics, and clinical outcomes were tracked and reported quarterly to labor and delivery team members.

Results: During the first eight months of the post-intervention period, there were 125 PPH events at time of vaginal delivery. PPH checklist use prior to QI interventions was 0%. After implementation, the rate of PPH checklist use rose to 59% (Figure). The survey response rate by delivery team members was 86%. PPH checklist use was less common in cases where the patients were Non-Hispanic Black or less than 35 years old (Table). PPH checklist use was more common on night shift.

Conclusion: At our institution, the use of QI methodologies led to an increase in PPH checklist use from 0% to 59%. The PPH checklist was less commonly used when the patient identified as Non-Hispanic Black or was less than 35 years old.

Primary & Presenting Author(s)

Johanna Quist-Nelson, MD
Attending Physician
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States

Coauthor(s)

SD
Shivani Desai, BS
University of North Carolina at Chapel Hill School of Medicine
Chapel Hill, North Carolina, United States
KR
Kelly Reilly, MA
University of North Carolina Hospitals
Chapel Hill, North Carolina, United States
AK
Arianna Keil, MD
University of North Carolina Hospitals
Chapel Hill, North Carolina, United States
Katharine Bruce, MPH (she/her/hers)
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
MS
Michelle Swanson, RN
University of North Carolina Hospitals
Chapel Hill, North Carolina, United States
BC
Benjamin Cobb, MD
University of North Carolina
Chapel Hill, North Carolina, United States
KZ
Katelin Zahn, MD
University of North Carolina at Chapel Hill School of Medicine
Chapel Hill, North Carolina, United States
CM
Christine McKenzie, MD
University of North Carolina
Chapel Hill, North Carolina, United States
EC
Elizabeth Coviello, DO
University of North Carolina at Chapel Hill School of Medicine
Chapel Hill, North Carolina, United States
Divya Mallampati, MD, MPH
Assistant Professor
University of California San Francisco
Chapel Hill, North Carolina, United States
LK
Lavinia Kolarczyk, MD
University of North Carolina at Chapel Hill School of Medicine
Chapel Hill, North Carolina, United States