From Postpartum Haemorrhage Guideline to Local Protocol: A Study of Protocol Quality

Mallory D. Woiski*, Helena C. van Vugt, Anneke Dijkman, Richard P. Grol, Marco Marcus, Johanna M. Middeldorp, Ben W. Mol, Femke Mols, Martijn A. Oudijk, Martina Porath, Hubertina J. Scheepers, Rosella P. Hermens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Web of Science)

Abstract

Objective Postpartum hemorrhage (PPH) has a continuously rising incidence worldwide, suggesting suboptimal care. An important step in optimizing care is the translation of evidence-based guidelines into comprehensive hospital protocols. However, knowledge about the quality of these protocols is lacking. The objective of this study was to evaluate the quality of PPH-protocols on structure and content in the Netherlands. Methods We performed an observational multicenter study. Eighteen PPH-protocols from 3 University Hospitals (UH), 8 Teaching Hospitals (TH) and 7 Non-Teaching hospitals (NTH) throughout the Netherlands were acquired. The structure of the PPH-protocols was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) Instrument. The content was appraised using previously developed quality indicators, based on international guidelines and Advance-Trauma-Life-Support (ATLS)-based course instructions. Results The quality of the protocols for postpartum hemorrhage for both structure and content varied widely between different hospitals, but all of them showed room for improvement. The protocols scored mainly below average on the different items of the AGREE-II instrument (8 of the 10 items scored <4 on a 1-7 scale). Regarding the content, adoption of guideline recommendations in protocols was 46 %. In addition, a timely indication of 'when to perform' a recommendation was lacking in three-fourths of the items. Conclusion This study shows that the quality of the PPH-protocols for both structure and content in the Netherlands is suboptimal. This makes adherence to the guideline and ATLS-based course instructions difficult.
Original languageEnglish
Pages (from-to)2160-2168
JournalMaternal and Child Health Journal
Volume20
Issue number10
DOIs
Publication statusPublished - Oct 2016

Keywords

  • Health care quality access and evaluation
  • Guideline adherence
  • Postpartum hemorrhage
  • Clinical protocols

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