The Postpartum Wellness Phone Call :A Usability and Feasibility Study

Background:Each year, more than 3.8 million births occur in the United States. Rates of severe pregnancy-related complications and deaths in the U.S. have been rising during the last 25 years. The American College of Obstetricians and Gynecologists recommends increased supervision of postpartum women in the weeks following delivery; however, implementation of this recommendation is difficult due to organizational standards and clinic resources. The purpose of this project was to determine the feasibility and usability of a third-week postpartum phone-based assessment protocol to mitigate postpartum complications that occur before the standard six-week postpartum visit.Methods:This project was designed to determine the usability of a postpartum phone-based assessment protocol and to explore its feasibility in a substance use and pregnancy program specialty clinic. The multidisciplinary clinic team met to identify common postpartum complications. These complications were connected with the most useful clinical assessment tools to create a third-week postpartum phone-based assessment protocol. The clinical nurse implemented the protocol with 11 postpartum patients. Implementation notes were kept during each phone call and included the interventions completed, time utilized, and challenges encountered. Following the six-week postpartum clinic visit, both patients (n=11) and the multidisciplinary clinic team (n=12) were surveyed to determine their satisfaction with the protocol. Data from the implementation notes, satisfaction surveys and patient outcomes were analyzed to determine the 2 feasibility and usability of this protocol within the substance use and pregnancy program.Results:Five assessment tools were identified and included in the intervention protocol: a bleeding assessment, substance use recovery status, EPDS score, breastfeeding status, and GAD-7 scoring. Protocol time with patients averages 96 minutes. Patient implementation of the protocol in the identification of postpartum complications for n of 11 patients and resulted in hospital readmission for one of the 11 patients, a 9% readmission rate. Post-protocol satisfaction surveys found that patient satisfaction averaged 4.25 on a scale of 1-5, with 5 indicating the highest level of satisfaction (n=11), and multidisciplinary team member satisfaction averaged 4/5 (n=12) using the same scale. Changes to clinical flow and patient treatment plan decreased the average first clinic visit in the postpartum visit from six weeks to 2.6 weeks in this intervention group, thus negating the protocol implementation. Conclusion:Both patients and the multidisciplinary team members reported satisfaction with the third-week postpartum protocol, and the protocol was determined to be usable for identifying postpartum complications before the six-week postpartum visit. At this time, the program was determined to not be feasible in the substance use and pregnancy program clinic because of resource management, patient availability, changes to the clinical flow, and a decrease in average time from delivery to first postpartum visit.