Obstetric Hemorrhage Initiative
The Florida Perinatal Quality Collaborative, in partnership with the District XII American College of Obstetricians and Gynecologists (ACOG), Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN), Florida Council of Nurse Midwives, Florida Hospital Association, and the Florida Department of Health, has developed this Obstetric Hemorrhage Initiative (OHI).
- Read our publication in the Maternal and Child Health Journal: The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff (2016)
- Florida's Pregnancy Associated Mortality Review (PAMR) committee has released a 2016 Urgent Maternal Mortality Message to Providers on Hemorrhage and Placental Disorders
- The Florida Obstetric Hemorrhage Toolkit was updated October 2015. Click Resources below to download the latest version of the recommendations.
OHI Round 2 Information and Resources
OHI’s 1st round was highly successful in hospitals improving quality practices. Florida hospitals that missed the first round are invited to participate in a second round of hospital driven OHI with support from the FPQC.
Suggested commitment length: Spend 1 year instituting recommendations and 6 months institutionalizing changes.
Click here to Sign-Up for Round 2. This is a non-competitive sign-up process, not an application. Hospitals contacts will be notified of the kick-off webinar, future learning session webinars for collaboration, receive OHI tools and data collection form, and technical assistance from FPQC and consultants.
There is no required data submission to the FPQC for round 2. Hospitals will lead their own internal initiative with FPQC providing tools and assistance.
- Provide online tools and resources to support hospitals in implementing process changes and improving documentation
- Convene a kick-off webinar and other online learning sessions to support a collaborative learning environment for hospitals in driving change
- Offer technical assistance and education from FPQC clinical advisors and staff to facilitate implementation.
- Provide hospitals with an OHI data collection tool so that they may track their progress and compare to the first round OHI hospitals on key measures.
Data Collection and Display Spreadsheet:
OHI Round 2 Data Entry and Display Spreadsheet Instructions
OHI Hospital Data Entry and Display Spreadsheet.xlsx Webinars:
Round 2 kicked off with an Orientation Webinar in February 2016.
In June of 2016 we held a Collaboration Webinar, where hospitals shared their challenge and successes in working on OHI:
Resources and Tool Box
- Florida Obstetric Hemorrhage Initiative (OHI) Toolkit updated October 2015
- OHI Hospital Data Entry and Display Spreadsheet
- OHI Hospital Data Entry Spreadsheet Instructions and Questions
- OHI Key Driver Diagram
- OHI Hospital and Patient Success Stories
Addtional Resources are available in the OHI Tool Box. The OHI Toolbox is organized on Box Cloud. This site has been approved by USF Health as HIPAA compliant:
If you cannot access Box on your hospital campus, please contact us to request files.
Printed materials available for OHI hospitals upon request from Florida hosptials:
- Florida's Obstetric Hemorrhage Initiative Toolkit
- OB Hemorrhage Stages Algorithm Poster
- Quantification of Blood Loss Poster
- "Have you Q.B.L.ed Today?" sticky note pads
- OB Harm Reduction Checklist and OB Hemorrhage Checklist from HRET
- Florida PAMR Urgent Message for Maternity Care Providers
- View AWHONN's video on How to Quantify of Blood Loss
- View Lee Memorial Health System's Tips and Tricks on Quantification of Blood Loss After Vaginal Birth video
- Free Online course: Quality Improvement in Obstetric Hemorrhage Management. 1 CME / 1.25 AMA PRA
- VHA network's Partnership for Patients Education Series recorded webcast with a focus on the Florida OHI and Baptist Hospital of Miami: Improving Maternal Outcomes of Obstetric Hemorrhage
OHI Round 1 Webinars
Webinar recordings and slides are archived on Box Cloud Storage. This site has been approved by USF Health as HIPAA compliant.
6.4.2015: Sustainability of OB Hemorrhage Projects
5.14.2015: End of Initiative Celebration
12.4.2014: OHI Success Stories
9.11.2014: Physician Champion Panel
6.12.2014: OHI 6-Month Check In and Progress Report
5.8.2014: Team Communication and Debriefing
4.10.2014: Quantification of Blood Loss
3.13.2014: OB Hemorrhage Simulation Drills
2.13.2014: Physician Engagement and Data Reports
1.16.2014: Massive Transfusion Protocols
12.5.2013: Data Collection and Hospital Implementation
OHI Round 1 Results31 Florida hospitals and 4 North Carolina hospitals participated in the OHI pilot phase from 2013-2015. Download the report below to view results of the initiative.
OHI Round 1 Final Data Report
OHI Speaker Bureau
If your hospital is interested in having a physician speak to your hospital team about the OHI, please contact us. Speakers may be from your region and can tailor presentations for your hospital's needs.
Hemorrhage, or severe bleeding, is the leading cause of pregnancy-related mortality worldwide and in the United States (Bingham et al, 2011; American College of Obstetricians and Gynecologists (ACOG) 2006). Postpartum hemorrhage has been defined as blood loss in excess of 500 mL following a vaginal birth or more than 1,000 mL following a cesarean birth (ACOG, 2006). It is estimated that one woman dies every four minutes from postpartum hemorrhage worldwide (ACOG, 2006). ). The pregnancy-related mortality ratio in the United States has increased to its highest levels in decades from 11.1 to 15.7 deaths per 100,000 live births from 1993 to 2006 (Creanga, 2012). Further, between 1994 and 2004 there was a 27.5% increase in postpartum hemorrhage deaths, primarily due to uterine atony, and a 92% increase in maternal blood transfusions (Bingham et al, 2011; Callaghan et al, 2010). Recent research indicates that “54 to 93% of these hemorrhage deaths may have been preventable” (Bingham and Jones, 2012).
Maternal hemorrhage is considered to be the most preventable cause of maternal mortality (Burke, 2010). Improved quality of medical care is the most important factor for the prevention of mortality due to obstetric hemorrhage. More than 90% of the potentially preventable morbidity and mortality due to hemorrhage is because of provider-related factors, notably incomplete or inappropriate management (Della Torre, et al, 2011). A 2011 study found that delay in treatment or diagnosis, ineffective management, and lack of proper preventive measures for hemorrhage led to preventable pregnancy-related deaths and extreme morbidity (Della Torre et al, 2011).
Although there is no clear trend, the pregnancy-related mortality ratio (PRMR) in Florida fluctuated from 13.3 in 2005 to 26.2 in 2009. Hemorrhage was one of the top three causes of maternal mortality, accounting for 15% of deaths during this time period. Most maternal deaths from hemorrhage were caused by ruptured ectopic pregnancy, uterine atony/postpartum bleeding, placenta accreta, percreta, or increta, and retained placenta (FL PAMR). Risk factors associated with deaths due to hemorrhage in Florida included lack of prenatal care, non-Hispanic Black race; having a cesarean delivery and advanced maternal age (FL PAMR).
In order to address Florida’s pregnancy-related mortality, the Florida Department of Health contracted with the Florida Perinatal Quality Collaborative (FPQC) to convene a group of maternal health, public health, and quality improvement leaders to work on a Maternal Mortality Prevention Initiative. The FPQC maternal mortality workgroup reached consensus that hemorrhage is one of the state’s most preventable maternal mortality issues and the highest priority because hemorrhage is one of the top causes of maternal mortality in Florida and because hospital and provider strategies to address the issue are highly feasible and effective.
Multi Hospital Collaborative
Hospitals are asked to spend 18 months implementing the recommended changes and 6 months institutionalizing them in their facilities.
Hospitals and providers participating in the OHI will be better prepared to assess for hemorrhage risks, prepare for and manage obstetrical hemorrhage in earlier stages, and measure their results. The FPQC helps Collaborative participants meet OHI goals by sharing the best available scientific knowledge, teaching and applying methods for organizational change, involving experienced hospital experts, and sharing participating hospital experiences, challenges, and successes.
Strategies are adaptable to all hospital settings and recognize that some facilities do not have the necessary equipment or trained professionals to utilize some of the higher technology or complex procedures and guidelines. There are core elements that are recommended in a priority order to be included in all locations, including participation in data collection for core metrics. Each facility either adopts an existing set of protocols or guidelines and tools or develop/adapts protocols or guidelines and tools using the evidence based elements. Collaborative hospitals learn improvement strategies that include establishing goals and methods to develop, and test and implement changes to their systems.
For more information on this initiative, please contact firstname.lastname@example.org 813-974-9654