Quality and Safety in Health Care最新文献

{"title":"Authors' response","authors":"J. Callen, A. Georgiou, Julie Li, J. Westbrook","doi":"10.1136/bmjqs-2011-000196","DOIUrl":"https://doi.org/10.1136/bmjqs-2011-000196","url":null,"abstract":"","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74738799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' response","authors":"A. Angelow, N. Black","doi":"10.1136/bmjqs-2011-000140","DOIUrl":"https://doi.org/10.1136/bmjqs-2011-000140","url":null,"abstract":"mammography justifiable? Lancet 2000;355:129–34. 4 Olsen O, Gotzsche PC. Cochrane review on screening for breast cancer with mammography. Lancet 2001;358:1340–42. 5 Kerlikowske K, Grady D, Rubin SM et al. Efficacy of screening mammography. A meta-analysis. JAMA 1995;273:149–54. 6 Duffy SW, Tabar L, Chen HH et al. The impact of organized mammography service screening on breast carcinoma mortality in seven Swedish counties. Cancer 2002;95:458–69. 7 Bulliard J-L, De Landtsheer J-P, Levi F. Results from the Swiss mammography screening pilot programme. Eur J Cancer 2003;38:1760–68. 8 Thornton H, Edwards A, Baum M. Women need better information about routine mammography. BMJ 2003;327:101–03. 9 Paling J. Strategies to help patients understand risks. BMJ 2003;327:745–48.","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83087396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BMJ Quality & Safety: new opportunities for better, safer healthcare","authors":"K. Shojania","doi":"10.1136/BMJQS.2011.052233","DOIUrl":"https://doi.org/10.1136/BMJQS.2011.052233","url":null,"abstract":"Quality and Safety in Health Care has established itself in recent years as the premier journal in the fields of quality improvement and patient safety. We now receive approximately 800 manuscripts a year, and the journal has an impact factor of 2.8, making it the highest impact journal in the field. A number of changes have occurred at the Journal in 2011, changes which will hopefully continue and enhance the trajectory of excellence established by the previous Editor, Dr David Stevens.1\u0000\u0000First, consistent with the large number of submissions, the Journal increased in publication from bimonthly to monthly as of January 2011. Second, the Journal's name changed to BMJ Quality & Safety to reflect not just the ownership, but also the BMJ Group's interest in highlighting healthcare improvement as part of its mandate. All of the major general medical journals have published articles related to healthcare quality or patient safety in the past 10 years. But, one could argue that the BMJ publishes the widest range of original research, reviews, commentaries, and debates on issues related to these topics. Most notably, the BMJ has published robust qualitative and mixed methods research,2 3 which are often poorly received at major general journals but represent crucial approaches to evaluating healthcare improvement initiatives. Given this sustained attention to healthcare quality in the BMJ , the new name for our journal seems particularly fitting.\u0000\u0000A third change at the Journal is its co-ownership by the Health Foundation and the BMJ Group. As readers in the UK probably know already, the Health Foundation (http://www.health.org.uk/) is an independent charity committed to improving healthcare systems. It pursues this mission by identifying important quality and safety challenges, collaborating with others to design innovative solutions to those challenges, and implementing …","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83443227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality lines","authors":"D. Stevens","doi":"10.1136/qshc.2010.048298","DOIUrl":"https://doi.org/10.1136/qshc.2010.048298","url":null,"abstract":"Turning administrative data into real-time clinically useful information The delivery of clinical care in isolation of data and information is no longer prudent or acceptable. Cardiothoracic surgical programs face increasingly more complex procedures performed on evermore challenging patients. Public and private stakeholders are demanding these programs report process-level and clinical outcomes as a mechanism for enabling informed clinical decision-making. Increasingly these measures are tied to reimbursement and institutional accreditation. This report describes the development of a system for linking administrative and clinical registries, in real-time, to track performance to satisfy both the needs of patients and stakeholders. Institutional performance is displayed over time using process control charts, and compared to both internal and regional benchmarks. Quarterly reports are automated for five surgical cohorts and are displayed externally on a dedicated website, and internally in the cardiothoracic surgical office suites, operating theatre, and nursing units. Monthly discussions are held with the clinical staff. Expanded applications are serving to integrate these data further into clinical care to drive process improvement. (See page 399)","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81201128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality lines","authors":"D. Stevens","doi":"10.1136/qshc.2010.043679","DOIUrl":"https://doi.org/10.1136/qshc.2010.043679","url":null,"abstract":"Adverse events between visits for patients with diabetes mellitus Adverse events between ambulatory patient visits are increasingly the focus of study. By means of an automated telephone self-management tool, 111 patients with diabetes mellitus were monitored for adverse events between visits in the course of their home management. Of note, the study population was ethnically and linguistically diverse, and most had longstanding and poorly controlled diabetes. Among these patients, 86% had at least one event detected over a 9-month study period totalling 111 adverse events and an additional 153 potential adverse events. Medication management was implicated as the dominant adverse event and constituted 63% of events. Of note inadequate clinician-patient communication was implicated in 59%. In fully 80% of all events, a combination of system, clinician and patient factors contributed to the adverse event. The authors suggest that patient-level self-management support and patient-centred communication offer the greatest opportunities for prevention of adverse events in this setting. See page 223","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75075656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"195 Impact of a multidisciplinary approach of invasive fungal infections from diagnosis to treatment","authors":"L. Florence, Mondain Véronique, Gari-Toussaint Martine, H. Lilia, S. Anne, Poirée Maryline, D. Thomas, Lucas-Daver Stéphanie, Berrouane Yasmina, Mousnier Aline","doi":"10.1136/qshc.2010.041624.8","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.8","url":null,"abstract":"Invasive fungal infections (IFI) are severe diseases affecting immuno-compromised patients. In France, since 2007, the cost of expensive recommended antifungal treatments (AFT) is not included in the normal per-case payment and each suspected IFI must be systematically documented during interdisciplinary team meetings (ITM) including an infectious disease specialist, a haematologist, a mycologist and a pharmacist. Objective To evaluate the impact of our ITM. Methods In 2008, 179 advices were provided in real time to prescribing doctors concerning 109 patients receiving AFT. This was done during 31 ITM. From January to September 2009, 192 advices were provided during 27 ITM, Each patient's condition was documented according to clinical presentation including emergency high resolution CT of the chest and abdomen, microbiological data as Aspergillus galactomannan antigen assay twice a week, pan-fungal PCR, and mycological analysis of various samples (bronchoalveolar fluid, blood culture…). Results In 2008, eight cases of probable and two of possible invasive aspergillosis (IA) were diagnosed (all in a haematology department, with one paediatric case). Four patients died: in one case IA may have been a causative factor. Incidence rate for IA was 4.7% among patients with acute leukaemia and stem-cell transplantation, which seems low compared to the literature. Advices were followed in 90% of cases. In 2008 and 2009 (until September), 95% of treatments involving added costs, were in line with provisions for marketing authorisation. Number of empirical AFT First half the year 2003 19/41(46%) First half the year 2008 7/23(30%) First half the year 2009 9/39(23%) To conclude, currently, 100% of patients benefit from a radiological and biological monitoring, in order to optimise the diagnosis and AFT. Thus, the empirical's antifungal (AF) number has been reduced from 46 to 23%. Indeed, we observed a 17% drop in added AF costs and 12% for other systemic AF (2007 vs 2008). A good compliance with the suggested advices shows that prescribing doctors are in favour of the scheme. The consumption of AF expressed in Daily Defined Dose will allow further assessment of practice trends. Les MFI sont des pathologies infectieuses sévères des patients immunodéprimés. Les traitements antifongiques (AF) systémiques recommandés font partie depuis 2005 des médicaments tarifiés en sus de l'activité. Depuis 2005, pour chaque suspicion de MFI une documentation systématique est demandée en cellule antifongiques (RCP hebdomadaire pluridisciplinaire: infectiologue, hématologue, mycologue, pharmacien) et les traitements AF en cours sont discutés. En 2008, 179 avis ont été communiqués en temps réel aux prescripteurs concernant 109 patients traités par AF. Ces avis ont été donnés au cours de 31 RCP au vu des données diagnostiques, microbiologiques et d'imagerie accessibles dans le dossier patient informatisé. Lors du 1er semestre 2009, 192 avis donnés au cours","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73998158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"251 OMAGE: OPTIMAL DRUG MANAGEMENT OF THE ELDERLY","authors":"S. Legrain, D. Bonnet","doi":"10.1136/QSHC.2010.041616.13","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041616.13","url":null,"abstract":"Context The elderly are at high risk of repeated hospitalisations, which are potentially hazardous and costly. Clinical experience and literature support the evidence that a high percentage of these unplanned hospitalisations are avoidable. The purpose of our study was to implement a new multi-component patient-centred intervention suited to elderly admitted in acute geriatric units (AGU) and to assess its impact 3- and 6-month- post-discharge on survival without unplanned readmission or emergency visit. Program A prospective multicentric randomised controlled trial conducted in six AGU. Participants were consecutive patients aged 70 years and over. Intervention was patient-centred, with no intervention after discharge. It had three components: prescription optimisation, a specific patient and/or carer's educative program and an enhanced coordination, with a focus on three topics: drug-related problems, depression and malnutrition. It was formalised to be implemented by four geriatrician investigators. Primary outcome was survival for 90 and 180 days without unplanned readmission or emergency visit (Kaplan–Meier analysis). Secondary outcomes were mortality, rate of readmitted patients, rate of patient with at least one emergency visits (Log rank test) and the number of readmissions and the number of days of readmission (Wilcoxon test). Results 665 patients were included (348 in usual care group (UC) and 317 in intervention group (IG)), with a mean age of 86.1 years. 66% were women, 47.4% lived alone; they had a mean of three chronic diseases and took a mean of seven daily chronic medications. The mean duration to perform the intervention was 3 h 30 min. Survival for 90 days without unplanned readmission or emergency visit was significantly higher in the IG than in the UC (p=0.0173). This trend persisted at 180 days but not significantly (p=0.06). At 90 days, the rate of patients readmitted in IG was decreased by 25% vs UC (21% vs 29.4%, p=0.0012). The number of readmissions and the number of days spent in acute care were significantly lower in IG vs UC (p=0.0218 and p=0.0472 respectively). The mortality in IG was lower but it was not statistically significant (p=0.055). At 180 days, the same trend was observed for the rate of readmitted patients, the number of readmissions and the mortality, but it was not statistically significant. Limits Only 665 patients were included instead of the planned 800 that could have induced a lack of potency and hindered to demonstrate the efficiency of the intervention at 6 months. Discussion This intervention could be proposed in other settings of geriatric care (rehabilitation, ambulatory care). Conclusion A complex but one-shot and geriatrician-directed intervention increases significantly survival without readmission at 3 months in unselected elderly inpatients. Contexte Les réhospitalisations sont fréquentes, potentiellement délétères et coûteuses chez les malades âgés. Mais, la fréquence des réhospi","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74400323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"025 Impact of a quality procedure on the survival of patients with malignant hyperthermia","authors":"R. Krivosic, B. Marciniak, L. Mazzoli, T. Depret, J. Salleron","doi":"10.1136/QSHC.2010.041608.3","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041608.3","url":null,"abstract":"Background and Objectives The mortality rate of malignant hyperthermia (MH) was 64% before the US Food and Drug Administration approved intravenous dantrolene in 1980. In France, a national formal quality procedure relative to the treatment of MH was issued in 1989 and updated in November 1999. It made the availability of an adequate stock of dantrolene compulsory and provided guidelines for MH management. Our objective was to analyse trends in mortality in proven MH cases in France. Programme We retrospectively reviewed the database of the MH unit at Lille hospital. The inclusion criteria for our review were the following: at least one positive halothane test (in vitro contracture test (IVCT)) in the surviving subject or a close relative and/or a MH causative mutation in the RyR1 gene. Informed consent was obtained from all patients and/or relatives. Statistical analysis was performed using SAS 9.1.3 Service Pack 4. Results There were a total of 115 MH cases between 1969 and 2007 (see Abstract 25 Table 1). Abstract 25 Table 1 Period MH N (%) Mortality N (%) Median age (IQ) Succinylcholine (%) Dantrolene (%) 1969–2007 115 35 (31) 16 (7–21) 50 46 1969–1979 22 (19) 13 (59) 14 (11–20) 76 0 1980–1989 37 (32) 14 (38) 13 (6–22) 64 42 1990–1999 41 (35) 7 (18) 15 (10–28) 39 68 2000–2007 15 (13) 1 (7) 20 (13–28) 8 60 p<0.002 NS p<0.007 p<0.001 Overall mortality was 31%. Mortality decreased significantly over time from 59% to 7%. The last two deaths occurred in 1995 and 2004. We observed no serious sequelae in survivors. Neither median age nor sex ratio (64% male) varied significantly over the four time periods; neither influenced mortality. Patients received a halogenated anaesthetic (≥90%) and/or succinylcholine (50%). Succinylcholine use decreased over time and was higher in the deceased (74%) than in survivors (43%). Discussion A strength of our study was that MH diagnosis was proven by IVCT and/or genetic analysis. The most striking observation was the trend towards zero mortality. This result does not support the recent report from the North American Malignant Hyperthermia Registry of the Malignant Hyperthermia Association1 which concluded that modern US anaesthetic practice did not prevent MH-associated cardiac arrest and death in predominantly young, healthy patients undergoing low - to intermediate-risk surgical procedures. We conclude that the positive impact on survival in our study was probably related to the national formal quality procedure for MH instigated by the French health authorities. Introduction La mortalité de l'hyperthermie maligne anesthésique (HM) était chiffrée à 64% avant le dantrolène injectable (1980). La France a rédigé une procédure qualité sous forme de circulaire, en 1989, modifiée en 1999 (Circulaire DGS/DH du 18 novembre 1999 relative au traitement de l'hyperthermie maligne (HM) peranesthésique). Le but de ce travail est d'étudier l'évolution de la mortalité au décours d'une crise HM prouvée par des tes","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76161202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"132 Automated analysis of compliance of medical decisions with clinical practice guidelines: use of decision algorithms in the management of patients with common or rare tumours","authors":"A. Lurkin, F. Ducimetière, C. Cropet, D. Cellier, O. Collard, F. Gilly, P. Biron, D. Salameire, J. Blay, I. Ray-Coquard","doi":"10.1136/QSHC.2010.041632.20","DOIUrl":"https://doi.org/10.1136/QSHC.2010.041632.20","url":null,"abstract":"Background and Objectives Published studies on medical practice assessment often use clinical audit as method. However, clinical audits require considerable resources, in particular human resources, as each medical file has to be reviewed individually. If the number of files is large, this can take time, with furthermore no guarantee that the results will be reproducible. Our objective was to develop algorithms for the automated analysis of compliance of medical decisions with national or regional clinical practice guidelines. Programme Our work was carried out within a financial and organisational partnership between Merck-Serono, the Cancéropole CLARA (Cancéropôle Lyon Auvergne Rhône-Alpes) and the European network of excellence CONTICANET (Connective Tissue Cancer Network). We based our work on medical practice appraisal studies we had performed on the management of patients with non metastatic breast cancer and of patients with sarcoma. We compared the use of human and automated means of assessing compliance with guidelines in a case that was common and one that was rare and required more complex management. We collected data on both types of case in each institution and compared treatment administered to treatment recommended for each patient. When patient management was in line with guidelines, it was considered to comply. When management deviated from guidelines without any medical justification, it was considered not to comply. We determined compliance with guidelines by an observer and by the algorithm and used the kappa coefficient to obtain a reliable and reproducible measure of concordance between the two methods. We then calculated algorithm sensitivity, specifically, positive predictive value (PPV) and megative predictive value (NPV). Results 586 treatments for breast cancer were assessed. kappa for concordance between observer and algorithm was 0.55, indicating that the algorithm is a partial substitute for the observer. Algorithm sensitivity was 46% and specificity was 99%. This means that if the algorithm states that treatment complies with guidelines, the observer need not review the file but can be certain that the answer is correct. This was confirmed by the PPV which was 95.7%. However, the NPV was lower (84.7%). Thus, when the algorithm indicates noncompliance, the observer has to check the decision in the patient's file. In a study of treatment decisions in patients with sarcoma (gastrointestinal stromal tumour (GIST) or retroperitoneal sarcoma), the kappa coefficient was only 0.27 for GIST and 0.13 for retroperitoneal sarcomas. These preliminary results need to be verified on soft tissue sarcomas which are more common. Discussion and Conclusion Our algorithm for analysing compliance with clinical practice guidelines is a useful tool for optimising medical practice assessment. It can help save time and human resources, improve reproducibility, and guarantee unbiased observer judgement. However, for widespread use of suc","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77153260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"028 Analysis of the impact of measures for the prevention of post-partum hemorrhages in a large maternity unit","authors":"H. Le Guen, O. Teffaud, O. Kick, G. Langlois, Berthereaux Lidwine, Prima Pierre-Yves, Multon Olivier","doi":"10.1136/qshc.2010.041624.39","DOIUrl":"https://doi.org/10.1136/qshc.2010.041624.39","url":null,"abstract":"Introduction In order to improve maternal safety and reduce the number of post partum hemorrhages in our obstetric unit, we have implemented a standardized standardised protocol for active risk management of post partum hemorrhage haemorrhage(1) and the establishment of a cross-fonctionnal work group. This work group was made up of the various actors involved in the birthing process including gynecologistsgynaecologists, midwives and anesthesiologistsanaesthesiologists. This study analyses the impact of our protocol on the occurence of post partum hemorrhagehaemorrhage. Materials and methods Following national guidelines, a written protocol for the prevention, early recognition, and management of post partum hemorrhage haemorrhage (PPH) was established in our institution in spring 2007. The primary objective of this protocol was the active management of third stage of labor labour and included the following: the administration of 5 UI oxytocin as the anterior shoulder delivers; a routine 2 h observation period after childbirth in the obstetric unit; in case of PPH, surgical exploration of lower genital tract and intravenous sulprostone within 30  minutes. We analyzed analysed data from 2006 (prior to the implementation of the protocol), 2007 (at the introduction of the protocol) and in 2008. Statistical analysis of the data was performed using the χ2chi-squared test and Fisher's exact test Results Year 2006 2007 2008 Child birth (n) 5126 5139 5055 Hemmorrhage total (n) 190(3.,70%) 157(3.,05%) 78(1.,54%)*** Hemmorrhage <1  l (n) 156(3%) 132(2.,6%) 46 (0.,9%)*** Hemorrhage Haemorrhage >1 l (n) 34(0.,66%) 25(0.,49%) 32 (0.63%) (NS) Transfusions (n) 12(0.,23%) 19(0.,37%) 33 (0.65%)** Active third stage (n) Non available 2102(48%) 3523 (83.3%)*** Cesarean section (n) 729 (14.,2%) 776 (15.,1%) 837 (16.5%)* * p<0.05; ** p<0.01; *** p<0.001. Discussion These results show the implementation of the PPH risk-management protocol significantly reduced the incidence of post partum hemorrhages. However, the results also show that the protocol failed to reduce number of occurrences of more serious PPH(>1  literl), the incidence of which was already low as compared with published data. (2). The presence of a senior obstetrician present with the midwife at delivery facilitated the application of the PPH protocol. The incidence of transfusions, although low, increased throughout the protocol evaluation period at 0.24% of births in 2006 compared to 0.63% in 2008. The increase in the rate of transfusion is may be due to: (1) the increased awareness of doctors leading to more rapid intervention at the occurrence of PPH and (2) a concomitant increase in the rate of caesarean sections performed over the protocol evaluation period. Contexte, objectif Dans le but d'améliorer la sécurité maternelle et de diminuer le nombre d'hémorragie de la délivrance, nous avons mis en place au sein de notre maternité une politique active de gestion du risque hémorragique du post ","PeriodicalId":20849,"journal":{"name":"Quality and Safety in Health Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78302499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}