The journey to reduce postpartum hemorrhage at Von Voigtlander Women’s Hospital
On May 2, a multidisciplinary team of clinicians and administrative staff from Von Voigtlander Women’s Hospital (VVWH) – also known as the Postpartum Hemorrhage (PPH) Optimization Team – celebrated their 18-month journey to optimize the prevention, recognition and management of postpartum hemorrhage in the VVWH Birth Center.
- Maternal hemorrhage leading to blood transfusions is a leading cause of maternal morbidity and remains a leading cause of maternal mortality worldwide.
- Reducing the need for blood transfusions reduces risk for a patient to develop further complications and decreases the use of a precious and limited resource.
In May 2020, Vizient results showed VVWH was having challenges in PPH performance. This triggered the team to further investigate VVWH’s performance using a nationally-recognized measurement: units of blood transfused per 1,000 live births.
Additionally, due to the COVID-19 pandemic, the U.S. faced a national blood shortage. This intensified the need to reduce the demand for blood products after childbirth.
Therefore, VVWH needed to make significant changes to improve the safety and quality of care provided to mothers and babies and to conserve a precious and limited resource.
The PPH Optimization team joined forces with Ashley Logan-Sitko and David Hyatt from the Clinical Design & Innovation team, a division of the Quality Department. The two guided the team through a phased, scientific problem-solving approach that included mapping of the current state, identifying opportunities for improvement, performing root cause analyses, developing countermeasures, and implementing process improvements.
Committed to SMART goals
The team identified SMART goals that focused on reducing the need for blood transfusion by optimizing the prevention, recognition and management of PPH at VVWH.
One of the goals identified by the team was to reduce the units of blood transfused per 1,000 births by 25 percent by June 2022.
The team had 4 areas of focus:
- Prenatal care
- PPH risk and medications
- Calling for help
- Team education and blood stewardship
The team implemented several countermeasures starting in July 2021:
- Prevention: recognize and treat prenatal anemia
- MiChart Best Practice Advisory (BPA) alerts when a patient’s lab results qualify the patient for iron therapies, either oral or IV infusion.
- Recognition: identify patients at risk
- MiChart Best Practice Advisory (BPA) reminds nurses to complete the PPH Risk assessment
- Color-coded sticker on the patient’s door increases team awareness of risk
- Medications to manage PPH are placed in the room for high-risk patients
- Management: call for help early
- The Early Warning Team is a multidisciplinary group who can respond to a PPH and provide additional resources to the treating team
- Management: Improve blood transfusion stewardship
- The “Start With One” educational campaign spreads awareness and encourages single-unit transfusions
At the end of April 2022, the team achieved its goal by reducing the number of units transfused per 1000 deliveries by 37 percent! The team will continue efforts to further reduce PPH and blood transfusions after birth.
Keys to success
A multidisciplinary team approach was key to having all perspectives represented both in current state analysis and future state design. The PPH Optimization team leveraged data and the team’s first-hand experiences to uncover root causes.
Additionally, the team embraced a Plan-Do-Check-Act cycle approach to implementing changes and conducted at-the-elbow education and simulations. By gathering feedback at several meetings, huddles, and rounds, the team was able to modify and adjust designed processes to best serve patients and staff.
Megan Bollinger, VVWH CNS, said, “What made this project successful is the team coming together for each action item. Every time we had a meeting, rounded with staff or even completed smaller tasks like laminating, these action items were almost always done with representation from multiple members of the team. It was a perfect example of the proverb ‘to go fast, go alone; to go far, go together.’ It took a lot of time, but we had each team member along for the whole ride.”
Overall, the PPH Optimization team was successful because they were committed to the project goals and maintained an openness to change. The team thanks the VVWH staff for their commitment to process improvement!