Methods: A quasi-experimental study was conducted in six district hospitals and three referral hospitals in one province of southern Thailand. Multifaceted intervention including educational outreach, audit and feedback, reminder and involvement of opinion leader was implemented. Doctors and nurses who are responsible on case management and care policy in the hospitals were participated in the intervention. The checklist of quality of care, developed from the evidence-based guidelines and assessed by the practicability, was used for medical record audit. One-year medical records of women diagnosed postpartum hemorrhage in participating hospitals before the educational outreach were reviewed using the checklist. The findings of audit were feedback to all doctors and nurses who acted as the opinion leaders during educational outreach. After the meeting, the list of care reminders was distributed and placed at the relevant wards and rooms. One-year medical records of postpartum hemorrhage were again reviewed using the same checklist. The improvement of quality of care was evaluated by comparing before and after intervention.
Results: One hundred and forty five health providers in all participating hospitals took part in the multifaceted intervention. For district hospital, 132 and 142 medical records of pregnancy diagnosed as postpartum hemorrhage in pre- and post-intervention period were reviewed. The diagnosis and general managements were generally improved. Indwelling of bladder catheter and hemodynamic monitoring were significantly increased in post-intervention period (p<0.001). Improvement of specific managements for uterine atony and retained placenta was found but not significant difference. For referral hospitals, 228 and 303 medical records of women with postpartum hemorrhage were reviewed. Hemodynamic monitoring was significantly improved. High rate of proper care was found and the significance of improvement could not be identified.
Conclusion: Quality of care for postpartum hemorrhage was improved by multifaceted intervention to health providers. The intervention should be extended to other hospitals and the effect of quality of care to severe maternal morbidity and mortality is needed to be monitored.