The Postpartum Hemorrhage Patient Safety Bundle Implementation at a Single Institution: Successes, Failures, and...

Area of Science:

• Obstetrics and Gynecology
• Patient Safety
• Healthcare Management

Background:

• Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality worldwide.
• A multidisciplinary consensus bundle for PPH management was published in 2015.
• Effective implementation of evidence-based bundles is crucial for improving clinical outcomes.

Purpose of the Study:

• To evaluate the successes and failures of an institutional implementation of a PPH patient safety bundle.
• To assess the acceptability and sustainability of individual bundle components.
• To analyze the impact of the bundle on institutional PPH and transfusion rates.

Main Methods:

• An interdisciplinary committee guided bundle implementation with cross-disciplinary teaching.
• Electronic medical record tools were developed for risk stratification, quantitative blood loss (QBL) calculation, and stage-based management.
• Bundle components were evaluated for acceptability and sustainability, alongside analysis of PPH and transfusion rates pre- and post-implementation.

Main Results:

• Readiness components (supply, protocol) were successfully implemented as "quick wins."
• Risk stratification was sustainable, but QBL faced resistance and was discontinued due to lack of superiority over estimated blood loss.
• Deficiencies were noted in response and reporting elements, specifically patient support and team debriefing, impacting overall sustainability and acceptability.

Conclusions:

• The PPH patient safety bundle facilitated stratified program implementation, with specific elements proving successful.
• Deficiencies in acceptability and sustainability, particularly concerning QBL and team communication, were identified.
• Continuous quality improvement and addressing cultural change are essential for optimizing PPH management bundles.