Obstetric Hemorrhage ECHO: On a Mission to Reduce Postpartum Hemorrhages in Utah

The Utah Department of Health was awarded a grant from the Association of Maternal and Child Health Programs (AMCHP) in an effort to address the third leading cause of maternal mortality in Utah-postpartum hemorrhaging. The first aim of the initiative was to improve the maternal mortality review process in Utah. The Utah Department of Health (UDOH) accomplished this by expanding their Maternal Mortality Review Committee to include guidance from multidisciplinary experts and incorporating a new case review form, adopted from the Ohio Department of Health. The second aim of the initiative was to work with Utah hospitals to implement components of the OB Hemorrhage Safety Bundle. Utah used its grant funds to hold an in-person project launch meeting with staff from over 50% of delivering hospitals and then hold fourteen bi-monthly learning sessions on the safety bundle components via Project ECHO. Positively affecting systemic public health issues like post partum hemorrhaging can be challenging for a variety of reasons ranging from changing the organizational culture at health facilities to affecting public attitudes and behaviors. Increasing access to education about best practices, however, is a step in the right direction.

OBSTETRIC HEMORRHAGE ECHO: On a Mission to Reduce Postpartum Hemorrhages in Utah 1 MHA , J. Holloman, MBA, L. Willis, T. Box, E. Clark, L. 1 2 3 Project ECHO , Division of Obstetrics & Gynecology , Utah Department of Health University of Utah Health Care INTRODUCTION The first aim of the initiative was to improve the maternal mortality review process in Utah. The Utah Department of Health (UDOH) accomplished this by expanding their Maternal Mortality Review Committee to include guidance from multidisciplinary experts and incorporating a new case review form, adopted from the Ohio Department of Health. The second aim of the initiative was to work with Utah hospitals to implement components of the OB Hemorrhage Safety Bundle. Utah used its grant funds to hold an in-person project launch meeting with staff from over 50% of delivering hospitals and then hold fourteen bi-monthly learning sessions on the safety bundle components via Project ECHO. In Utah, hemorrhage is the 3rd leading cause of maternal mortality: 1. Embolism 2. Overdose/drug toxicity 3. Hemorrhage 4. Cardiac 5. Infection 3.2% Utah's PPH rate Reach of Every Mother Initiative Project ECHO The Utah Department of Health was awarded a grant from the Association of Maternal and Child Health Programs (AMCHP) in an effort to address the third leading cause of maternal mortality in Utah-postpartum hemorrhaging. 1 MS , 1 MD , 2 MD , 3 Baksh Extension for Community Healthcare Outcomes PROGRAM DESCRIPTION DISCUSSION The use of the Project ECHO model has allowed for interactive learning sessions among hospitals statewide. The UDOH utilized this model as a way to connect disparate sites on a regular basis in an effort to improve knowledge, training, and outcomes regarding post partum hemorrhaging. The UDOH's decision to use Project ECHO as their method for disseminating information to various health facilities across the state ultimately saved participants over 10,000 miles and 180 hours* of travel. *Based on the number of participating facilities multiplied by their respective distances (in miles) from the Utah Department of Health in Salt Lake City multiplied by 2 (in order to represent roundtrips). List of Sites Ashley Regional Medical Center Beaver Valley Hospital Brigham City Community Hospital Cache Valley Hospital Castleview Hospital Central Valley Medical Center Davis Hospital and Medical Center Garfield Memorial Hospital Jordan Valley Hospital Kane County Hospital Lakeview Hospital Logan Regional Hospital Lone Peak Hospital McKay-Dee Hospital Riverton Hospital Salt Lake Regional Medical Center Sanpete Valley Hospital St. Mark's Hospital Unlike the traditional Project ECHO model, the OB Hemorrhage ECHO sessions did not utilize case presentations as a method of instruction, but rather relied entirely on didactic presentations and group discussions to facilitate learning. Additionally, considering the temporary nature of the program, the UDOH used one of the ECHO sessions to review evaluation survey results with participants and also to gain real-time feedback. Every Mother Initiative ECHO Schedule 10,000 miles and 180 hours of travel saved, which equates to 865 miles and 15 hours per health facility. Over Evaluation of the success of the Every Mother Initiative will be based on a comparison between post partum hemorrhage rates before and after the implementation of the program. Pending the results of the evaluation, Project ECHO at UUHC may be utilized for further UDOH projects like this one. The use of Project ECHO for the Every Mother Initiative is one example of how University of Utah Health Care (UUHC) is working with the partners like the Utah Department of Health to solve health issues that affect the citizens of Utah. Positively affecting systemic public health issues like post partum hemorrhaging can be challenging for a variety of reasons ranging from changing the organizational culture at health facilities to affecting public attitudes and behaviors. Increasing access to education about best practices, however, is a step in the right direction. ACKNOWLEDGEMENTS University of Utah Health Care - TeleHealth Services, University of Utah Department of Obstetrics & Gynecology Clinicians and Staff, University of Utah Project ECHO Staff, the ECHO Institute, Utah Department of Health. Utah's maternal transfusion rate is >2 fold higher than the national average