Implementation of a Prenatal Hemorrhage Risk Screening Tool: A Quality Improvement Initiative

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Early identification of risk during pregnancy is essential for optimizing care. This quality improvement (QI) study evaluates the implementation of a prenatal hemorrhage risk assessment integrated into the electronic health record (EHR).

As part of a systemwide QI initiative, a prenatal PPH risk assessment tool was developed and embedded in the EHR in 2023 to identify patients with risk factors during the prenatal period. A retrospective chart review assessed adherence to screening across 28 outpatient obstetric clinics between October 2023 and June 2024. A subset analysis of patients screened from October to December 2023 examined risk levels, risk factors, adherence to recommendations, and delivery outcomes.

Between October 2023 and June 2024, 4,688 birthing people completed their first prenatal visit, of whom 93.6% (n = 4,390) were screened. In the subset analysis, 12.0% (n=131) were classified as moderate risk and 13.0% (n = 139) as high risk. Common moderate-risk factors included > 4 vaginal deliveries (33.6%, n = 44) and body mass index (BMI) > 50 (19.1%, n = 25). Among high-risk patients, prior PPH (55.4%, n = 77) and prior cesarean delivery (16.5%, n = 23) were the most frequent risk factors. Of the high-risk cohort, 92.8% (n = 129) received a blood bank consultation, and 9.4% (n = 13) experienced PPH at delivery.

Embedding a prenatal hemorrhage risk assessment into the EHR with standardized workflows supports timely referrals, consultations, and resource allocation. Automated alerts and multidisciplinary coordination enhance clinical decision-making and care cohesion. This approach offers significant potential for improving maternal outcomes, particularly in resource-limited settings.