Quantitative Blood Loss (QBL) at every delivery: a quality improvement initiative utilizing Electronic Medical Record tools

Maternal hemorrhage is a major cause of maternal morbidity and mortality in the United States and efforts are in place to eliminate preventable harm. Accurate assessment of blood lost around the time of birth is essential for timely recognition and intervention. As part of the Alliance for Innovation on Maternal Health (AIM) Obstetrical Hemorrhage Patient Safety Bundle at our institution a quantitative blood loss (QBL) calculator was created within the electronic medical record. This process allows for real-time tracking of cumulative blood loss measurements and is built with triggers to alert the care team when criteria for various hemorrhage stages are achieved along with suggested interventions and assessments. The consistency of implementation and efficacy of the QBL calculator was evaluated by following both utilization of the calculator flowsheet as well as tracking of rates of erroneous QBL values, defined by negative values and cesarean deliveries with QBL2019, 14 months after implementation and post three system-based improvements. By the end of this implementation review the calculator was in use consistently at all cesarean deliveries with improved confidence in the process by providers