1. Evaluation of a clinical protocol for the management of fever in labor among pregnant women at term: A quality‐improvement study.
- Author
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Spénard, Elisabeth, Tordjman, Laurent, Marrié‐Mas, Ann‐Elisabeth, Dal Soglio, Dorothee, Eberle, Alexa, Labbé, Annie‐Claude, and Boucoiran, Isabelle
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PREGNANT women , *MEDICAL protocols , *NEONATAL sepsis , *CHORIOAMNIONITIS , *LABOR (Obstetrics) , *FEVER , *HOSPITAL costs - Abstract
Objective: To assess the impact of a quality‐improvement initiative designed to increase diagnostic accuracy and adequate management of clinical chorioamnionitis (CC) at a tertiary center. Chorioamnionitis occurs in 1%–13% of term pregnancies and increases maternal and neonatal peripartum complications; often over‐diagnosed, it leads to unnecessary investigations and treatments. Methods: This was an interrupted time‐series study. In September 2017 two interventions were implemented: (1) staff training and (2) standardized clinical protocol for the management of fever in labor. All singleton term pregnancies were included. CC cases were reviewed in the pre‐intervention (2015–2016, n = 179) and post‐intervention (2017–2018, n = 142) groups. CC criteria based on the American College of Obstetricians and Gynecologists guidelines, antibiotics, maternal and neonatal outcomes, and pathology were compared. A cost–consequence analysis was performed. Results: Incidence of CC decreased from 8.2 to 5.6 per 10 person‐year (P < 0.001). This was associated with a significant increase in diagnostic accuracy from 15.7% to 73.2% (P < 0.001). Weight‐adjusted tobramycin dosage improved from 8.8% to 69.1% (P < 0.001). Maternal length of hospitalization and readmissions decreased significantly, without affecting neonatal sepsis rate. Interventions decreased yearly hospital costs associated with CC by 23.4%. Conclusion: Standardizing the management of fever in labor significantly increased the diagnostic accuracy of CC and decreased the misuse of antibiotics in term pregnancies. CC costs decreased by 23.4%. Synopsis: Education on chorioamnionitis and implementation of a standardized clinical protocol increase the diagnostic accuracy of chorioamnionitis and decrease the misuse of antibiotics in term pregnancies. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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