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Multifaceted Intervention to Improve the Quality of Care for Postpartum Hemorrhage

Objective: To evaluate the effect of a multifaceted intervention on the quality of care and clinical outcomes for postpartum hemorrhage (PPH) as measured by adherence and acceptability to indicators of PPH management at district and referral levels. Methods: A quasi-experimental study of interventions was conducted to improve healthcare for PPH in 6 district and 3 referral hospitals in southern Thailand. Multifaceted intervention included educational outreach, audit and feedback, reminders, and the involvement of an opinion leader. Physicians and nurses responsible for case management and care policies (145 individuals) in the aforementioned hospitals participated in the intervention. Medical records were reviewed considering the checklist of indicators for district and referral levels. Results: All indicators for PPH management were accepted by at least 80% of the participants, except for surgical intervention. We reviewed the medical records of 805 women diagnosed with PPH. Of these, during the preand post-intervention periods, 132 and 142 were from district hospitals, and 228 and 303 from referral hospitals, respectively. The use of an indwelling bladder catheter and hemodynamic monitoring were significantly increased in the post-intervention period. Conclusion: Quality of care for postpartum hemorrhage improved after implementing a multifaceted intervention targeting healthcare providers. The results of this study can be applied to other hospitals with a similar setting regarding the eligible criteria. Severe maternal morbidity and mortality from PPH should be monitored.