Purpose: To investigate a
resident-driven quality improvement lean event to improve satisfaction in PPH
management.
Background: Interdisciplinary PPH
response strategies are recommended as standard of care. OBGYN resident
perceptions regarding PPH management prompted an interprofessional quality
improvement lean event to create a systems process change on the post-partum
unit.
Methods: This was
a pre-/post-intervention study evaluating the impact of a lean event that
created new hemorrhage protocols (intervention) on postpartum units including:
medication safety bundle, assigned/clarified roles for providers, and a
streamlined communication process. The survey queried respondents regarding
team communication, access to uterotonics and analgesia, and perception of
overall patient safety during PPH. It was administered to resident physicians
and post-partum nurses prior to the system changes and at 6 and 12-month
intervals. These results were compared using nonparametric analyses.
Results: Participants
included 15 residents and 16 nurses. Pre-intervention, there was a significant
difference in the overall perception of safety when comparing resident and
nurse response (p=0.0495) with residents perceiving a less safe environment.
Post-intervention, overall satisfaction among the 2 groups was improved at the
6 & 12 month intervals (p<0.05) without discrepancy between the
groups. Nurse results demonstrated significantly increased satisfaction
with team communication and IV access protocols (p<0.05).
Discussions: Resident led quality
improvement events can result in improved satisfaction of interprofessional
team members in PPH care with improvements maintained over 12 months. Reaching
a shared perception and mental model between nursing and residents in the care
of PPH can further be studied from the patient’s perspective.
Topics: CREOG & APGO Annual Meeting, 2019, Resident, Faculty, Osteopathic Faculty, Residency Director, Patient Care, Systems-Based Practice & Improvement, GME, General Ob-Gyn,
Sara LaRue,
DO, Mercy
Hospital St. Louis; Sara Wood, MD, MHPE
