A quality improvement and educational initiative to reduce morbidity associated with massive postpartum hemorrhage

Abstract

Objective To determine the effect of a quality improvement and educational initiative on blood transfusion rates and patient morbidity from massive postpartum hemorrhage. Methods A retrospective chart review was performed of massive postpartum hemorrhage (mPPH) at an urban tertiary care center. Inclusion criteria are women with mPPH over 20 weeks gestational age. The primary outcome was the number of packed red blood cell (pRBC) transfusions required. Two time periods were compared—the control period (January 2006–December 2011), and the educational period (January 2012–December 2015) by calculating an incidence rate ratio using Poisson regression. Results Among 189 women with mPPH, 107 cases occurred during the control period and 82 during the educational period. In the educational period, there were 13% (95% confidence interval [CI] 2%–23%) fewer pRBC and 16% (95% CI 1%–29%) fewer fresh frozen plasma (FFP) units transfused compared with the control period. There was a decrease of 58 minutes (95% CI −106 to −9.52) of the median time from diagnosis of mPPH to transfusion of FFP. Conclusion The quality improvement educational initiative decreased the number of pRBC and FFP transfusions required, and shortened the latency interval to transfusion of FFP.

International Forum on Transfusion Education for Healthcare Professionals Who Administer Blood to Patients in Hospitals and Health Services: Summary

“…Previous publications demonstrated the importance of provider-related factors and compliance of the massive transfusion protocols in improving patients' outcomes [13,14]. Use of simulation and other educational initiatives have been documented to improve adherence and application of massive transfusion protocols [15][16][17]. There is a need to span such educational initiatives on a broad range of healthcare providers, considering the multidisciplinary nature of the teams involved in managing a bleeding patient.…”