The AIM (Alliance for Innovation on Maternal Health) Obstetric Hemorrhage (OBH) Quality Improvement Project (QIP) is a quality improvement project that falls under the larger Maternal Safety Quality Improvement initiative sponsored by the Ohio Department of Health (ODH). The leading causes of pregnancy-related death in Ohio include cardiovascular and coronary conditions, infections, hemorrhage, preeclampsia and eclampsia, and cardiomyopathy, and a review of all pregnancy-related deaths from 2012-2016 found that over half of these deaths were preventable. In order to reduce the rate of preventable deaths attributed to obstetric hemorrhage events in Ohio, targeted interventions at the provider, hospital, and system levels are required.
The AIM OBH QIP is administered by the Ohio Colleges of Medicine Government Resource Center (GRC), and in partnership with The Ohio State University’s Wexner Medical Center, the Cleveland Clinic Foundation, and the Ohio Hospital Association. The AIM OBH QIP seeks to address severe maternal morbidity and mortality by implementing best clinical practices and quality improvement tools to treat obstetric hemorrhage in the prenatal and postpartum period. In addition, through collaboration with clinical leaders and state partners, the project aims to prioritize a focus on health equity in order to achieve the goal of reducing disparities in maternal care.
In the first phase of the project, an advisory group comprised of project partners developed a clinical change package based on best practices identified by the American College of Obstetricians and Gynecologists and the California Maternal Quality Care Collaborative to help establish practice guidelines for maternity hospitals in Ohio. The change package incorporated evidence-based interventions centering on the “5 R” domains established in the AIM patient safety bundles, including Readiness, Recognition, Response, Reporting, and Respectful and Equitable Care. With the support of quality improvement coaches, participating sites will test strategies and interventions to implement best clinical practices, including risk assessments, quantified blood loss, recognition of urgent maternal warning signs, and drills and simulations.
Data from each participating site’s Electronic Health Record (EHR) will be submitted and analyzed on a quarterly basis to track project progress and provide a feedback mechanism for each team to evaluate the performance of PDSA testing cycles.
In 2022, the initial wave of the AIM OBH QIP activity engaged 30 maternity hospital and will begin active QI implementation in October. Subsequent waves will leverage lessons learned during the initial phase regarding quality improvement activities and data submission and analysis.