Increasing effective postpartum care in an obstetric clinic using ACOG's postpartum toolkit.

Abstract

Background: Approximately 69% of maternal mortality occurs in the postpartum period. Contributing factors include the absence of preparation of pregnant women for the postpartum period during the antenatal period, postpartum follow-up care not being scheduled until 6 weeks after childbirth, and the lack of further care coordination.

Aim: The aim of this project was to increase the frequency of effective postpartum care visits to 80% in 8 weeks at an urban obstetric clinic.

Methods: A quality improvement project was conducted through four Plan-Do-Study-Act cycles over 8 weeks.

Interventions: Postpartum Readiness & Awareness Tools (PRATs) were reviewed with patients during their late third trimester, to review postpartum warning signs that warrant further evaluation. A population health registry was created to manage early follow-up for newly postpartum patients, to ensure their recovery was progressing normally. A note template was created and implemented to guide the completion of comprehensive postpartum visits.

Results: Over 8 weeks, 188 patients received 1 of the 3 standardized interventions. Effective postpartum visits increased to 88%. The PRATs increased patient postpartum warning sign knowledge, with a project mean risk factor knowledge score of 6 (Goal = 5). The population health registry drove right care by ensuring early postpartum patients were recovering as expected, as seen by a project mean right-care score of 16 (Goal = 12). The note template increased the effectiveness of postpartum visits, with a mean effective postpartum care score of 10 (Goal = 10).

Conclusions: The PRATs, population health registry, and note template collectively increased the quality and effectiveness of postpartum care.