Quantitative blood loss: a quality improvement project in a rural perinatal surgical unit

Abstract

BACKGROUND: Quantitative blood loss (QBL) provides a more accurate assessment of intraoperative blood loss during cesarean delivery than visual estimation. Reliance on visual estimation can delay recognition of postpartum hemorrhage, a leading cause of preventable maternal morbidity and mortality. Accurate and timely measurement is especially critical in low- volume rural hospitals, where limited resources and delayed response time can have significant consequences. LOCAL PROBLEM: At the project site, a rural critical access hospital (CAH) in northwest Montana, QBL was not performed during cesarean deliveries, representing a deviation from established standards of obstetric care. METHODS: The project used the Institute for Healthcare Improvement Model for Improvement to implement a standardized QBL protocol, combining workflow changes, staff education, and use of a QBL worksheet to support accurate measurement and documentation during cesarean deliveries. Data were collected through electronic health record audits at scheduled intervals, and iterative Plan-Do-Study-Act cycles guided adjustments. INTERVENTION: Two interventions were initiated: Surgical staff education on QBL and a QBL worksheet listing the dry weights of all materials. RESULTS: The project aims were partially achieved, with 82% of staff completing QBL education. Three cesarean deliveries occurred during implementation; all utilized the QBL worksheet, and corresponding QBL values were documented in the electronic health record. CONCLUSION: CAHs can successfully integrate standardized QBL processes into cesarean workflows with minimal disruption. Sustained use of QBL supports earlier recognition of postpartum hemorrhage, improving the quality of care, maternal outcomes, and patient safety.