LAS VEGAS (Jan. 23, 2017)—In a study to be presented Friday, Jan. 27, in the oral concurrent session at 1:15 p.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, researchers with Community Medical Center in Missoula, Montana; Uniformed Services University of the Health Sciences, Bethesda, Md.; and Wilford Hall Ambulatory Surgery Center, San Antonio, Texas, will present their study titled, SAFE PASSAGES implementation reduces perineal trauma.
In 2013, the Department of Defense participated in the Partnership for Patients program to reduce iatrogenic (caused inadvertently by a physician or surgeon or by medical treatment or diagnostic procedure) patient harm. Recognizing that some of the trauma and tears associated with labor could be reduced, a specific program for harm reduction was developed called SAFE PASSAGES. The SAFE PASSAGES term is memory prompt for a series of interventions for managing childbirth that reduce the chances and severity of childbirth trauma. For example the first “E” is “Eliminate midline episiotomy”. One military service used this program and other two services instituted other programs that encouraged reduced rates of harm in childbirth but offered no specific programmatic recommendations for reduction. This study evaluated the effectiveness of SAFE PASSAGES training on the incidence of perineal trauma in the Department of Defense.
Of the three programs reviewed, SAFE PASSAGES showed the greatest reduction in the rate of harm (63.6%) at the same time having a decrease in cesarean delivery rates. At hospitals where the SAFE PASSAGES program was implemented with on-site didactic and simulation training, the rate of severe perineal lacerations was reduced by over 300%.
“I believe that the principles taught and propagated in the SAFE PASSAGES program could go a long way toward keeping the cesarean rate down, even improving the rate, while reducing the overall risk of trauma in child birth” stated Merlin B. Fausett, M.D., maternal-fetal medicine specialist with the Community Medical Center and the presenter of the research at the SMFM annual meeting. Dr. Fausett continued, “If one considers a cesarean as trauma, these principles can really help reduce the risk of trauma to mother either through avoiding unnecessary cesareans or reducing trauma in vaginal birth while even potentially reducing the risk of trauma to babies as well. The program includes training in support of forceps and vacuum deliveries and quality repair of tears when they do occur. This study definitively shows that applying the techniques taught in the SAFE PASSAGES program can really help to reduce the risk of harm to mother and baby during childbirth.”
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A copy of the abstract is available at http://www.smfmnewsroom.org and below. For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).
About the Society for Maternal-Fetal Medicine
The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed. For more information visit www.smfm.org.
Abstract 54 SAFE PASSAGES implementation reduces perineal trauma
Merlin B. Fausett¹ , Barton C. Staat² , Jamie D. Crosiar³ , Shad Deering² ¹Community Medical Center, Missoula, MT, ²Uniformed Services University of the Health Sciences, Bethesda, MD, ³Wilford Hall Ambulatory Surgery Center, San Antonio, TX
OBJECTIVE: In 2013 the Dept. of Defense (DoD) participated in the Partnership for Patients (PfP) program to reduce iatrogenic patient harm. The incidences of 3rd & 4th degree perineal lacerations after operative vaginal delivery (Patient Safety Indicator (PSI) 18) and vaginal delivery without instruments (PSI 19) were addressed. Prior to PfP implementation, baseline rates were measured in Military Treatment Facilities (MTFs) in each of the 3 DoD Medical Services (Army, Navy, Air Force). One Service, (Service X) developed a specific program for harm reduction – SAFE PASSAGES (SP). The other Services (Y and Z) encouraged reduced rates but did not provide specific programmatic recommendations for reduction. The SP program included a specific set of interventions associated with reduced perineal injury (Figure 1). We evaluated the effectiveness of SP training on the incidence of perineal trauma in the DoD.
STUDY DESIGN: We used a prospective cohort design. Baseline PSI 18 and 19 rates for each of the DoD Services were established using year 2010 delivery data (n = 272,161). Implementation occurred in 2012. Baseline rates were compared to post implementation (2013 through 3rd quarter 2014) rates (n ¼ 451,446). All but 1 MTF in Service X received SP training either as a 4-hour on-site workshop or an interactive webinar.
RESULTS: For PSI 18, Service X showed the greatest reduction in the rate (63.6%) while Service Y showed some improvement (15.5%) and Service Z had a non-significant worse rate (-12.6%) – Table 1. Overall, there was an improvement in PSI 18 (19%; p < 0.01) and a trend to improvement for PSI 19 (5.8%; p = 0.066) across the services. For PSI 19, again Service X showed the greatest improvement (41.8%). For Service X MTFs that received on-site training, PSI 18 rates decreased from 18.5/1000 to 6.0/1000–a 309% improvement (p = 0.012). All but one Service X MTF with webinar training showed some improvement. The one Service XMTF without SP training had increased rates of PSI 18 and 19. Notably, Service X cesarean delivery rates decreased by 1.63% while neonatal morbidity did not change during the study period.
CONCLUSION: Standardized training can be used to reduce perineal trauma rates without increasing cesarean or neonatal trauma rates. Implementation of the SAFE PASSAGES program may be a useful tool for broader implementation.