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Ohio haemorrhage quality improvement project: initial implementation of the Alliance for Innovation on Maternal
Katherine Jenkins1, Allison Lorenz2, Michelle C Menegay2
1The Ohio Colleges of Medicine Government Resource Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA katherine.jenkins@osumc.edu.
Background:
Obstetrical haemorrhage is a common complication of childbirth, and all patients are at risk for haemorrhage. Mortality attributable to haemorrhage has been decreasing in the USA, but the incidence of haemorrhage has continued to increase. In Ohio, one-third (31%) of all pregnancy-related deaths in 2020 were due to causes other than infection, mental health or embolisms, with 3% of those attributed to haemorrhage. Haemorrhage was the third leading cause of pregnancy-related death in the state from 2008 to 2016.
Methods:
Sponsored by the Ohio Department of Children and Youth, the Hemorrhage Quality Improvement Project (QIP) applies the Institute for Healthcare Improvement's methodology to implement structured quality improvement (QI) activities to improve key measures and implement the Alliance for Innovation on Maternal Health's Obstetric Hemorrhage Patient Safety Bundle. Hospitals provided patient data and completed surveys. Data from participating hospitals were used to calculate and monitor improvement in primary process measures (quantitative blood loss and haemorrhage risk assessment).
Results:
Across Ohio, 22 delivery hospitals spanning 13 health systems participated in the Hemorrhage QIP pilot. Participating hospitals achieved a statistically significant improvement in all process measures, including quantitative blood loss documentation (both overall and when limited to vaginal deliveries) and in the completion of haemorrhage risk assessment between admission and delivery.
Conclusions:
The Hemorrhage QIP demonstrates feasibility of a statewide QI initiative to improve care for women who experience obstetrical haemorrhage. Delivery hospitals have clinical expertise to improve outcomes related to postpartum haemorrhage care. Providing opportunity for peer-to-peer learning, evidence-based resources and QI coaching within a replicable QI project creates an opportunity to reduce preventable morbidity and mortality caused by an obstetric haemorrhage.
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