2. Proactive management of postpartum hemorrhage can reduce overall postpartum hemorrhage rates, in addition to reducing hemorrhage rates between racial groups.
3. African-American race is not included into the ACOG validated postpartum hemorrhage risk assessment despite being recognized as a major risk factor for the condition.
Healthcare disparities result in an additional $93 billion in yearly medical expenses. In order to address these disparities, National Patient Safety Goal 16 seeks to develop a strategy framework to improve equity in healthcare and analyze data on quality and safety to identify disparities in healthcare delivery. The United States exhibits the highest mortality rate among pregnant and postpartum individuals when compared to other developed nations. African American or Black women have a substantially higher risk of pregnancy-related death, with a 3.3-fold increased probability compared to non-Hispanic white women. Postpartum hemorrhage (PPH) is the primary cause of maternal death during pregnancy. To address PPH, a multi-tiered approach to proactive management was implemented across this MTF. Upon admission the labor and delivery, all females underwent a modified postpartum hemorrhage risk assessment score based on the ACOG clinically validated PPH risk assessment scale - with the addition of African American race as 1 point, lowering their threshold to meet "high risk" criteria for PPH. In addition, a code purple cart was made available in all high risk rooms, and patient banding was performed at admission for all high risk patients. Following the 8-month intervention phase, overall rates of post-partum hemorrhage dropped from 8%-7%. When accounting for race, post-partum hemorrhage rates fell most significantly for Asians (20% -6%), and African Americans (11%-6%), both of which demonstrate a reduction in the margin of disparity when compared to post-partum hemorrhage rates compared to whites (8%-6%). We believe that this 58% decrease in PPH in African American or Black patients after implementing the change in risk assessment, high risk patient banding, and improved communication has the potential to drive policy change within the MHS.