Joseph Naima T, Worrell Nikkia H, Collins Janice, Schmidt Melanie, Sobers Grace, Hutchins Kathlyn, Chahine E Britton, Faya Christine, Lewis Luanne, Green Victoria L, Castellano Penny Z, Lindsay Michael K
Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
Department of Quality, Grady Health System, Atlanta, Georgia.
AJP Rep. 2020 Jul;10(3):e255-e261. doi: 10.1055/s-0040-1714713. Epub 2020 Sep 2.
Postpartum hemorrhage (PPH) is a leading cause of preventable maternal morbidity and mortality. Standardized response to obstetric hemorrhage is associated with significant improvement in maternal outcomes, yet implementation can be challenging. The primary objective is to describe the methodology for program implementation of the Alliance for Innovation on Maternal Health Safety Bundle on PPH at an urban safety-net hospital. Over an 18-month period, interventions geared toward (1) risk assessment and stratification, (2) hemorrhage identification and management, (3) team communication and simulation, and (4) debriefs and case review were implemented. Hemorrhage risk assessment stratification rates were tracked overtime as an early measure of bundle compliance. Hemorrhage risk assessment stratification rates improved to >90% during bundle implementation. Keys to implementation included multidisciplinary stakeholder commitment, stepwise and iterative approach, and parallel systems for monitoring and evaluation Implementation of a PPH safety bundle is feasible in a resource-constrained setting.
产后出血（PPH）是可预防的孕产妇发病和死亡的主要原因。对产科出血的标准化应对与孕产妇结局的显著改善相关，但实施起来可能具有挑战性。主要目标是描述在一家城市安全网医院实施孕产妇健康安全捆绑创新联盟产后出血项目的方法。在18个月的时间里，实施了针对（1）风险评估和分层、（2）出血识别和管理、（3）团队沟通和模拟以及（4）汇报和病例审查的干预措施。随着时间的推移，跟踪出血风险评估分层率作为捆绑措施依从性的早期指标。在捆绑措施实施期间，出血风险评估分层率提高到了90%以上。实施的关键包括多学科利益相关者的承诺、逐步迭代的方法以及并行的监测和评估系统。在资源受限的环境中实施产后出血安全捆绑措施是可行的。
