Obstetric Anal Sphincter Injury Care Bundle: A Quality Improvement Initiative

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2024年9月27日

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T. Clark Powell,
Tanya P. Hoke,
Kyle P. Norris,
Margaret R. Page,
Allison Todd,
David T. Redden,
Cynthia G. Brumfield,
J. Michael Straughn Jr.,
Holly E. Richter

摘要

Introduction and Hypothesis

The objective was to implement an evidence-based peri-partum care bundle for women sustaining obstetric anal sphincter injuries and to evaluate compliance with recommendations for antibiotics use, repair in the operating room, and follow-up before and after implementation.

Methods

This project was reviewed by the Institutional Review Board and determined to be exempt. A clinical care bundle containing education and standardized orders in the electronic medical record was implemented. Characteristics of pre- (October 2017 to September 2019) and post-intervention (October 2019 to August 2021) cohorts were compared and compliance with recommendations for antibiotics use, surgical repair location, and follow-up were evaluated. Chi-squared, Fisher’s exact, ANOVA F, and Kruskal–Wallis tests were performed, as indicated. Significance level was p < 0.05.

Results

A total of 185 cases were identified. Seventy-five percent of women were nulliparous. Mean gestational age was 39 weeks. Pre- and post-intervention groups did not differ in age, BMI, race, parity, gestational age, comorbidities, birthweight, or delivery type. Ninety-eight cases were identified pre-implementation. Eighty-six (88%) had third-degree lacerations. Post-implementation, 87 cases were identified. Seventy (80%) had third-degree lacerations (p = 0.17). Recommended antibiotic-type use improved from 35% pre-implementation to 93% post-implementation (p < 0.001). Repair in the operating room was similar pre-implementation and post-implementation (16.0% vs 12.6%, p = 0.48). Post-partum follow-up within 2 weeks improved from 16.3% pre-implementation to 52.8% post-implementation and mean time to follow-up was shorter post-implementation than pre-implementation (18 vs 33 days; both p < 0.001).

Conclusions

Implementation of an evidence-based peri-partum care bundle resulted in standardization of care in accordance with established recommendations. Compliance with recommendations for surgical repair in the operating room remained unchanged.