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Implementation of a multidisciplinary clinical pathway for the management of postpartum hemorrhage: a retrospective study

Authors
 HEE YOUNG CHO  ;  SUNGWON NA  ;  MAN DEUK KIM  ;  INCHEOL PARK  ;  HYUN OK KIM  ;  YOUNG-HAN KIM  ;  YONG-WON PARK  ;  JA HAE CHUN  ;  SEON YOUNG JANG  ;  HYE KYUNG CHUNG  ;  DAWN CHUNG  ;  INKYUNG JUNG  ;  JA-YOUNG KWON 
Citation
 INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol.27(6) : 459-465, 2015 
Journal Title
 INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE 
ISSN
 1353-4505 
Issue Date
2015
MeSH
Adult ; Clinical Protocols* ; Female ; Humans ; Interdisciplinary Communication* ; Medical Audit ; Postpartum Hemorrhage/therapy* ; Retrospective Studies
Keywords
SPEED ; clinical pathway ; postpartum hemorrhage
Abstract
OBJECTIVE: To compare the outcomes of postpartum hemorrhage (PPH) episodes before and after the introduction of a clinical pathway known as the Severance Protocol to save postpartum bleeding through Expeditious care Delivery (SPEED). DESIGN: This study was designed as a retrospective analysis. SETTING: The study was conducted in a hospital implementing SPEED. PARTICIPANTS: The non-SPEED group included 74 patients with PPH who were treated before the introduction of SPEED, whereas the SPEED group included 155 patients. METHODS: Differences in outcomes were compared between groups. MAIN OUTCOME MEASURES: Reduction in treatment duration was the primary outcome measure, whereas uterus preservation was the secondary. RESULTS: No significant intergroup differences were observed for hemoglobin levels, hematocrit values and vital signs upon patients' emergency room arrival. The turnaround time for hemoglobin, mean duration until treatment by obstetricians and gynecologists and duration between chest radiography ordering and performance significantly differed between the two groups (SPEED, 10.0 [1.0-30.0], 3.0 [0-25.0] and 23.0 [1.0-86.0] min, respectively; non-SPEED, 17.0 [1.0-37.0], 12.0 [0-62.0] and 46.0 [1.0-580.0] min, respectively; P < 0.001). Similarly, the mean duration until transfusion of cross-matched red blood cells (SPEED, 77.6 ± 58.6 min; non-SPEED, 103.4 ± 64.4 min; P = 0.015) and uterus preservation rate (SPEED, 90.1% [136/151]; non-SPEED, 81.7% [58/71]; P = 0.043) also differed significantly between the groups. CONCLUSIONS: Clinical pathways enable prompt and efficient care for patients experiencing PPH through faster evaluation and access to red blood cell transfusion, resulting in a decrease in maternal mortality.
DOI
10.1093/intqhc/mzv068
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Ja Young(권자영) ORCID logo https://orcid.org/0000-0003-3009-6325
Kim, Man Deuk(김만득) ORCID logo https://orcid.org/0000-0002-3575-5847
Kim, Young Han(김영한) ORCID logo https://orcid.org/0000-0003-0645-6028
Kim, Hyun Ok(김현옥) ORCID logo https://orcid.org/0000-0002-4964-1963
Na, Sungwon(나성원) ORCID logo https://orcid.org/0000-0002-1170-8042
Park, Yong Won(박용원)
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
Jung, Inkyung(정인경) ORCID logo https://orcid.org/0000-0003-3780-3213
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/156797
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