STEP 1: The DCPQC’s first step is to engage champions to advocate and support improvement projects that address maternal and infant health across the District
The DC PQC uses multiple data-driven quality improvement (QI) models such as Plan-Do-Study-Act methodology, Six Sigma and Lean to address city-wide needs and priorities.
STEP 2: Multidisciplinary teams are formed to implement the quality improvement process.
STEP 3: Data is collected, analyzed and shared over time with the DCPQC group and other stakeholders. This allows the team to understand the root causes and barriers to prioritize improvement processes.
STEP 4: Continuous monitoring of data allows the team to evaluate successes and identify areas for further improvement.
Current QI Project
Between 2016 and 2019, 16% of birthing patients had gestational or pre-existing hypertension. In response, the DCPQC began implementing the Alliance for Innovation on Maternal Health’s (AIM) Severe Hypertension in Pregnancy patient safety bundle in all five of the District’s birthing hospitals in August 2021. The percentage of birthing facilities that have patient education materials on urgent postpartum warning signs increased from 0% in Q4 2021 to 80% in Q3 2023. Between Q4 2021 and Q4 2023, the proportion of women receiving Timely Treatment of Persistent Severe Hypertension increased from 35.9% to 85.4%. The DC PQC is now in sustainability mode for the Severe Hypertension in Pregnancy patient safety bundle. The AIM Severe Hypertension in Pregnancy Maternal Patient Safety Bundle provides guidance to hospitals to coordinate and standardize the care provided to women with severe hypertension during pregnancy and in the postpartum period.
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According to the Alliance for Innovation on Maternal Health (AIM), “postpartum hemorrhage is a leading cause of preventable, pregnancy-related illness and death, with an estimated 54-90% of all OB hemorrhage related deaths being preventable.” For the first three quarters of 2023, 11% of women experienced hemorrhage during a DC hospital birth admission. Of those, 21% experienced severe maternal morbidity (excluding transfusion).
We are excited to announce the DC Perinatal Quality Collaborative’s (DC PQC) effort among birthing centers to reduce maternal mortality and severe maternal morbidity and provide safe care for every mother. As DC birthing hospitals move forward with sustaining their hypertension related improvements, the DC PQC is prepared to pivot to focus on other important maternal health issues in support of quality improvement. The DCPQC began working on the AIM Hemorrhage bundle in April 2024.
The AIM Obstetric Hemorrhage in Pregnancy Patient Safety Bundle provides guidance to hospitals to coordinate and standardize the care provided to women with obstetric hemorrhage during pregnancy and in the postpartum period.
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QBL Sprint
Over several weeks, we collaborated with hospital teams to strengthen QBL measurement practices aligned with the AIM bundle. This included reviewing workflows, identifying barriers, and sharing practical tools and strategies to support accurate and consistent QBL tracking. The tools and resources provided helped standardize approaches across sites and enhance team confidence in performing this critical step in hemorrhage response.
- Data Collection Plan
- PDSA Template
- A3 Template
- Stakeholder Analysis Tool
- Prioritization Matrix
- Root Cause Analysis
- 30-60-90-Day Plan
- AIM Statement Worksheet
- QI Testing Presentation Slides
- QBL Sprint Feedback Survey
Hemorrhage Respectful Care Initiative
This work is currently underway. We are focused on improving how teams conduct post-event debriefs, with a particular emphasis on communication, trauma-informed care, and emotional support for patients who experience postpartum hemorrhage. Our goal is to elevate the quality of interactions with patients during and after critical events by refining debriefing processes aligned with the AIM bundle.
Mothers Autonomy in Decision Making Scale (MADM)
Developed by women to describe their experiences of maternity care. The MADM scale is a reliable and valid tool that rates the level of agency and autonomy that a person experiences when participating in decision- making conversations with a maternity provider.
DCPQC Postpartum Hemorrhage Patient Debriefing Form
This tool is designed to support clinical teams in facilitating thoughtful, patient-centered debrief conversations following a postpartum hemorrhage event. It helps ensure that both the physical and emotional aspects of the patient’s experience are addressed. The form includes key prompts to guide the discussion, reinforce trauma-informed communication, and provide patients with relevant information on recovery, bonding, breastfeeding, and available local and national support resources.
DCPQC Sample Script
This sample script is designed to support hospital teams in debriefing with patients after a hemorrhage event. It serves as a guide to help ensure the conversation is trauma-informed and patient-centered. The script was developed with input from doulas, patient partners, and hospital care teams, and is intended to promote respectful, clear, and compassionate communication.
Future QI Projects
The Alliance for Innovation on Maternal Health’s (AIM) Perinatal Mental Health Conditions Patient Safety Bundle provides guidance to hospitals to coordinate and standardize the care provided to women with perinatal mental health conditions during pregnancy and in the postpartum period.
The DC PQC is working on forming a Perinatal Mental Health Planning Workgroup in preparation for the implementation of the perinatal Mental Health Conditions Patient Safety Bundle. This planning group will meet to identify and establish treatment and resources needed to implement the bundle in our future QI work.
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The Alliance for Innovation on Maternal Health’s (AIM) Postpartum Discharge Transition Patient Safety Bundle provides actionable steps that can be adapted to a variety of facilities and resource levels to improve quality of care and outcomes during a critical period in which patients are at risk for morbidity and mortality.
The DC PQC is working on forming a Postpartum & Transitions of Care Workgroup to focus on the connection between hospitals and primary care/outpatient services. This workgroup will meet to identify priorities and develop an action plan to close any gaps in the transition of care between hospitals and outpatient services.
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