1. OBSTETRIC HEMORRHAGE ECHO:
On a Mission to Reduce Postpartum Hemorrhages in Utah
J. Holloman, MBA, MHA1, L. Willis, MS1, T. Box, MD1, E. Clark, MD2, L. Baksh3
Project ECHO1, Division of Obstetrics & Gynecology2, Utah Department of Health3
University of Utah Health Care
PROGRAM DESCRIPTIONINTRODUCTION
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.
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.
DISCUSSION
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.
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.
Extension for Community Healthcare Outcomes
Every Mother Initiative ECHO Schedule
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 maternal transfusion rate is >2 fold higher than the national average
Utah’s PPH rate
ReachofEveryMotherInitiativeProjectECHO
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
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).
Over 10,000miles and 180hours of
travel saved, which equates to 865miles and
15hours per health facility.
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.