Reduction of Postpartum Hemorrhage Through Quality Improvement Science

Background Regarding causes of avoidable maternal mortality, Postpartum Hemorrhage (PPH) remains in first place in the world and second in Brazil. Considering the latent need for improved diagnostic and therapeutic approaches to PPH, a multidisciplinary team from Hospital Israelite Albert Einstein (HIAE) developed an Institutional Protocol based on Improvement Science. Aim To assess the impact of this protocol on the reduction of maternal morbidity due to postpartum hemorrhage (PPH) within the institution. Methods Observational, descriptive, retrospective study comprising all parturient attended during childbirth at HIAE Morumbi unit from January 2017 to December 2021. Data were obtained from the Business Intelligence (BI) information system, with no identification of patients. The examined indicators were evolution of quantity and weight of surgical pads used during childbirth assistance (outcome), adherence rate to the counting and weighing of pads (process) and incidence of unused blood reserves (equilibrium). Exclusion criterion: blood reserves not associated with hemorrhagic complications during childbirth. The statistical analysis was based on execution diagrams that demonstrate the evolution of indicators over short intervals, thereby enabling a temporal evaluation of the implemented strategies’ effects. Results Adherence to the counting and weighing of used pads during childbirth exhibited a significant change within the first month of the protocol's implementation. The average quantity and weight of used pads showed a marked and sustained reduction. Beside subsequent use, there was an increase on the average quantity of unused blood reserves. Conclusion The process changes engendered by the new protocol have facilitated a reduction in blood loss during the births assisted at the unity over the considered period.