Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Consensus Guideline Implementation, EMR Reminder,

Intervention Description: With assistance from the clinical informatics department, a postpartum-specific note template was created in the electronic health record (EHR) to increased adherence with counseling guidelines recommended by the American College of Obstetrics and Gynecology (ACOG). The template addressed birth spacing, breastfeeding, contraception, depression, and sleep/fatigue, as well as comorbidities requiring follow-up (abnormal Pap smear, gestational diabetes mellitus, and pre-eclampsia). Patients were seen in a resident-run clinic: 100 consecutive visits occurred prior to implementation of the template, while 100 consecutive visits occurred post-implementation with use of the template.

Intervention Results: In visits that occurred without use of the template, counseling was charted as low as 1.0% for birth spacing to as high as 86.0% for contraception. With use of the template, counseling was charted as 100% in all visits for each of the recommended counseling guidelines (all p < 0.001).

Conclusion: A postpartum specific EHR note template shows improvement in adherence with recommended postpartum counseling. We propose that managers in hospitals and clinical practices create OBGYN-specific EHR note templates for clinical use to potentially improve documentation quality. This may increase adherence to documentation of postpartum counseling, with the ultimate goal of increasing adherence to evidence-based counseling guidelines.

Study Design: Retrospective cohort study

Setting: Resident run clinic, Nassau University Medical Center

Population of Focus: Postpartum patients

Sample Size: 200

Age Range: Mean age 30

Intervention Components (click on component to see a list of all articles that use that intervention): Consensus Guideline Implementation, Note-Taking (caregiver),

Intervention Description: Four core interventions were created for this project. The population health management registry tracked postpartum patients for early postpartum follow‐up. Patients who were 1–3 weeks postpartum were placed on the registry. Two providers (nurse‐midwife and OB/ GYN physician) called patients to ensure they were progressing as expected, with complications referred for either an in‐person office visit or for urgent evaluation in Labor & Delivery or the Emergency Department. The electronic postpartum note template guided review and documentation of ACOG's recommended visit components for postpartum visits. Clinic staff and providers were educated regarding the use of the tools. No incentive was provided for tool use.

Intervention Results: The project aimed to increase the frequency of effective postpartum care visits from 0% to 80% in 8 weeks. The frequency of effective postpartum care visits was 88% by the end of PDSA Cycle 4. The PRATs increased patient postpartum warning sign knowledge, with a project mean risk factor knowledge score of 6 (Goal = 5). The population health registry drove right care by ensuring early postpartum patients were recovering as expected, as seen by a project mean right‐care score of 16 (Goal = 12). The note template increased the effectiveness of postpartum visits, with a mean effective postpartum care score of 10 (Goal = 10).

Conclusion: The Postpartum Readiness and Awareness Tools (PRAT), population health registry, and note template tools improved quality and postpartum care effectiveness over 8 weeks. It is suggested that the PRAT and note template be sustained to increase anticipatory guidance and adherence to postpartum counseling guidelines. It is also recommended that pre‐scheduled telemedicine visits be implemented for early postpartum follow‐ up. Continued tool utilization can increase patient knowledge of postpartum warning signs, early postpartum follow‐up, and comprehensive 6‐week postpartum visits. Further studies are needed to examine the impact of the interventions on clinic‐ specific patient postpartum morbidity and mortality and differ- ences by race.

Study Design: Quality improvement project consisting of four rapid Plan-Do-Study-Act (PDSA) cycles

Setting: Ob/gyn practice in a large academic hospital in the eastern U.S.

Population of Focus: Postpartum patients

Sample Size: 188 patients

Age Range: Childbearing age