Improving follow up for postpartum women at a rural critical access hospital: a quality improvement project

Abstract

Background: Approximately 800 U.S. women die annually from pregnancy-related complications according to Croke (2019) and at least 60% of these deaths are considered preventable. Critical access hospitals and rural healthcare facilities are under-resourced causing healthcare disparities for rural populations. Closing the gap by initiating contact with postpartum women will help ensure postpartum appointments are made and patients do not slip through the cracks. In April 2018, The American College of Obstetrics and Gynecology (ACOG) recommended 12 weeks of support with the first postpartum evaluation within the first 3 weeks after delivery in-person or by phone with a comprehensive visit scheduled no later than 12 weeks (Lopez-Gonzalez & Kopparapu, 2022). Local Problem: The United States has a maternal death rate higher than any other developed country. Montana has the 6th highest rate of maternal deaths in the U.S. (Glover, 2021). In critical access hospitals obstetric outcomes are worse than those at high-volume hospitals and rural populations have a 9% greater probability of severe maternal morbidity and mortality (Woo & Glover, 2021). Methods: This quality improvement project will follow the Iowa model of evidence-based practice to promote excellence in healthcare. Intervention: Two follow-up calls after discharge from delivery, one at 72 hours and one at 7 days post-discharge. Results: The 72-hour call was completed 100% of the time, with all three women receiving the initial call. The seven-day call was completed 66% of the time, with only two women receiving the second call. Follow-up appointments were in place for each participant by the second discharge call, meeting the goal of 100%. Conclusions: The results of this project aligned with the literature with improved patient and provider satisfaction, early identification of patient needs for follow-up, and the use of phone calls provided an ideal alternative to increase accessibility and improve maternal outcomes with the advantages of flexibility, individualized care, and privacy.