Improving the Diagnosis and Treatment of Obstetric Sepsis

Problem: Maternal mortality affects women during four phases of obstetrics, including triage, antepartum, labor & delivery, and postpartum. In the U.S., sepsis is the third leading cause of maternal death. Inconsistent screening practices and delays in recognizing symptoms can occur in any phase. These factors were identified as root causes in a northern California community hospital with 600 monthly deliveries. Context: Two maternal sepsis cases cost $90,000 annually. A standardized pathway was initiated nationally in October 2023 through the California Maternal Quality Care Collaborative (CMQCC). One regional hospital system initiated a quality improvement project over 5 months within a community hospital and referral center for high-risk patients. Interventions: An informatics clinical decision support (CDS) intervention- Best Practice Alert (BPA) – was introduced into the electronic health record (EHR). New electronic and educational workflows were tested. Measures: Three process measures were utilized to monitor BPA workflows and satisfaction among clinicians (n=20). These included timely nursing assessment within 2 hours; timeliness of physician orders; and completion of pre/post implementation surveys. Results: A reduction in time to detection resulted from early alerts and expedited clinical evaluations. Timely administration of antibiotics under 30 minutes improved by 96%; improved adherence to the CMQCC sepsis pathway occurred and provider feedback (n=20) indicated 90% satisfaction. Conclusion: New BPA workflows reduced variation and increased standardization. All phases of the staff experience were positively affected. Maternal sepsis outcomes can be expected to improve with judicious selection of CDS tools and associated provider training across systems in obstetric care delivery.