Background
Method
Setting
Design and population
Patients
Professionals
Surveys among the professionals
Data collection
Patients
Professionals
Surveys among the professionals
Analysis
Patients and professionals
Surveys among the professionals
Results
Study population
Patients
Professionals and survey among professionals
N (318) | (%) | ||
---|---|---|---|
Gender | Male | 64 | 20 |
Female | 254 | 80 | |
Position | Obstetricians | 119 | 37 |
Obstetricians in training | 94 | 30 | |
Midwifes | 61 | 19 | |
Nurses | 44 | 14 | |
Type of hospital | University Hospital | 105 | 33 |
Teaching Hospital | 155 | 49 | |
Non Teaching Hospital | 58 | 18 | |
No. of deliveries per year | <1000 | 38 | 12 |
1001–1500 | 110 | 35 | |
1501–2000 | 75 | 24 | |
>2000 | 95 | 30 |
Influencing factors from patient perspective
Domain | Obstacles | Stated by No of patients (n = 12) |
---|---|---|
The professionals (n = 18) | Poor information to the patient about PPH | 9 |
Poor information to the partner/family about the patient’s medical condition, the risks and medical procedures | 7 | |
Patient feels not being taken seriously by the professional | 6 | |
Professionals panic when PPH occur | 4 | |
Incorrect/no information about policy of future deliveries | 4 | |
The organisation (n = 7) | Lack of information material like folders and website | 7 |
The patient has to deal with many different clinicians | 3 | |
Facilitator (n = 4) | Patient information material/website is facilitating for patient information | 3 |
Professional factors
Organisational factors
Influencing factors from professional perspective (interviews and survey)
Domain (No barriers found) | Obstacles | Mentioned in No of interviews |
---|---|---|
Guideline (n = 18) | Items of the PPH-guideline and ATLS-based course instructions are not included in the local hospital protocol | 4 |
The PPH-guideline is difficult to obtain at the delivery ward | 3 | |
Recommendations and definitions in the PPH-guideline are unclear | 3 | |
Professional (n = 28) | Professionals lack awareness regarding the importance of the recommendations of the guideline and ATLS-based course | 4 |
Professionals experience a feeling of time pressure | 4 | |
Professionals overestimate their knowledge regarding identifying the patient-categories at risk for PPH and regarding the treatment of high-risk patients and patients with PPH | 4 | |
Professionals are overconfident regarding their ability to estimate the blood loss without the use of a weighing-scale | 4 | |
Professionals lack to detect high-risk patients at the outpatient clinic | 4 | |
Social setting (n = 7) | Lack of communication in the team responsible for the patient, about the risks, policy, seriousness of the situation or actions that need to be taken | 4 |
Uncertain leadership caused by lack of knowledge about each other’s knowledge and expertise. This is caused by inexperienced professionals and frequent change of team composition | 4 | |
Disagreement between team members and with personnel of other disciplines about the seriousness of the situation (blood-bank personnel and anaesthesiologists) | 3 | |
Lack of team collaboration as orders are not followed and team members prefer following their own instincts in treatments, which leads to inconsequent policy | 3 | |
Presence of hierarchy leads to dread, for team members find it difficult to call in a gynaecologist who is at home and speak freely against the supervisor when there is a disagreement about policy | 3 | |
Organisation (n = 30) | Materials necessary for treatment of patients with PPH are not direct available | 3 |
Shortage of (qualified) staff | 3 | |
Skills/team trainings are not organised or not organised on a regular basis | 3 | |
Lack of practical tools at the delivery rooms, such as checklist/flowchart for easier and practical use of the guideline | 3 | |
Lack of finance | 3 | |
Complication discussions are not organised on a structural basis because it is too time consuming | 3 | |
Facilitators (n = 30) | The availability of a checklist/flowchart about PPH at the delivery rooms would improve care | 4 |
Training on using a checklist/flowchart about PPH would improve care | 4 | |
Skills/team trainings on a regular basis improve care | 3 |
Domain: Guideline | Overall % | Obstetricians % | Obstetricians in training % | MidWifes % | Nurses % |
---|---|---|---|---|---|
The national guideline lacks a flowchart to use in acute situations | 55 | 54 | 69 | 48 | 39 |
My local protocol does not say you should establish a policy for the delivery of a high-risk patienta | 39 | 33 | 38 | 48 | 43 |
My local protocol does not say you should consider a manual placenta removal at 500 ml blood lossa | 39 | 34 | 36 | 59 | 30 |
I have to find out myself that there is an update of the guideline | 35 | 29 | 36 | 34 | 50 |
The guideline is difficult to obtain in our delivery room | 27 | 27 | 23 | 30 | 34 |
My local protocol does not say you should weigh blood loss for every high-risk patienta | 26 | 17 | 27 | 27 | 25 |
You cannot use the national PPH-guideline in acute situations | 25 | 24 | 29 | 25 | 16 |
Domain: Professional | |||||
Measuring the urine output is low on my list of priorities | 57 | 44 | 65 | 66 | 55 |
I don’t have enough skills to perform surgical interventions (B-lynch etc.) | 50 | 30 | 77 | NA | NA |
Professionals are not aware that warm saline infusion is beneficial | 50 | 35 | 63 | 61 | 50 |
The recommendations for >1000 ml blood loss are less important when a patient lost 1000 instead of 1500 ml | 25 | 23 | 30 | 31 | 14 |
We do not weigh the blood loss for every high-risk patient when it is estimated as little | 36 | 24 | 49 | 44 | 32 |
I don’t have enough knowledge to perform surgical interventions (B-lynch etc.) | 27 | 7 | 53 | NA | NA |
I don’t have enough knowledge about bimanual compression | 26 | 11 | 33 | 56 | NA |
Domain : Social setting | |||||
Lack of experience of the team members with the use of warm saline infusion | 50 | 45 | 53 | 56 | 48 |
Working with inexperienced obstetricians (in training) is an obstacle | 30 | 20 | 36 | 34 | 39 |
Domain: Organisation | |||||
There is a need for more skills and drills | 53 | 42 | 67 | 57 | 50 |
In my hospital it is not possible to give a patient warm saline infusion | 50 | 40 | 49 | 59 | 68 |
Complication discussions are not multidisciplinary | 44 | 31 | 65 | 43 | 34 |
Time is an obstacle for organising skills and drills | 38 | 36 | 51 | 31 | 27 |
Not every delivery room has material to measure urine output | 36 | 18 | 33 | 57 | 61 |
The multidisciplinary arrangements are not tight enough | 33 | 2 | 42 | 30 | 27 |
Organising debriefings is too time consuming | 32 | 29 | 39 | 33 | 23 |
Complication discussions are not organised on a regular basis | 30 | 17 | 48 | 31 | 25 |
Facilitators | |||||
A flowchart about PPH in the delivery room would improve care | 63 | 50 | 73 | 68 | 58 |
A checklist about PPH in the delivery room would improve care | 57 | 51 | 56 | 63 | 60 |
There is a need for more skills and drills | 53 | 42 | 67 | 57 | 50 |
A second gynaecologist on duty for only emergencies would help me to quickly consult an extra gynaecologist | 30 | 26 | 34 | NA | NA |