Obstetric Anal Sphincter Injury Care Bundle: A Quality Improvement Initiative.

Autor: Powell TC; Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6Th Ave S, 176F Suite 10382, Birmingham, AL, 35233, USA. thomaspowell@uabmc.edu., Hoke TP; Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6Th Ave S, 176F Suite 10382, Birmingham, AL, 35233, USA., Norris KP; Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6Th Ave S, 176F Suite 10382, Birmingham, AL, 35233, USA., Page MR; Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA., Todd A; Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA., Redden DT; Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL, USA., Brumfield CG; Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA., Straughn JM Jr; Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA., Richter HE; Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, 1700 6Th Ave S, 176F Suite 10382, Birmingham, AL, 35233, USA.
Jazyk: angličtina
Zdroj: International urogynecology journal [Int Urogynecol J] 2024 Sep 27. Date of Electronic Publication: 2024 Sep 27.
DOI: 10.1007/s00192-024-05885-2
Abstrakt: 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.
(© 2024. The Author(s).)
Databáze: MEDLINE
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