Implementing E-Learning to Enhance the Management of Postpartum Hemorrhage.

OBJECTIVE

To determine if perinatal outcomes related to postpartum hemorrhage could be improved by blending existing strategies with the use of an online, assessment-driven electronic learning (e-learning) platform.

DESIGN

The Institute for Healthcare Improvement's Model for Improvement provided a structure for this performance improvement project. Outcome evaluation was further supported by the Kirkpatrick model.

SETTING/LOCAL PROBLEM: Reports of rising maternal morbidity and mortality in the United States prompted action within a multisite health system. Maternity care teams were determined to proactively support excellence in practice through enhancements to continuing education.

PARTICIPANTS

Maternity providers and nurses practicing within the organization completed the training.

INTERVENTION/MEASUREMENTS: Online, assessment-driven learning modules for maternity emergencies were blended with existing instructor-led courses, simulation, and Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) training in early 2017. In addition, a postpartum hemorrhage safety bundle was implemented. Outcome measures included rates of hemorrhage, massive transfusion, and intensive care unit admission for women admitted for childbirth. Outcome measures were tracked using retrospective chart review with baseline period October 1, 2016, through March 31, 2017, and performance period April 1, 2017, through March 31, 2018.

RESULTS

Improvements in perinatal outcomes were observed. The average rate of hemorrhage decreased by 3% (from 56.4/1,000 to 54.7/1,000). Median massive transfusion rates decreased by 35% (from 2.3/1,000 to 1.5/1,000). Similarly, the median rate of maternal intensive care unit admissions decreased by 77% (from 3.1/1,000 to 0.7/1,000). A downward shift was supported with zero intensive care unit admissions for 6 of the last 7 months (n = 4,422 pregnant women or women who experienced birth during the current admission).

CONCLUSION

Excellence in the management of postpartum hemorrhage was supported through a multipronged approach that included the use of an online e-learning platform for maternity emergencies.