Update on progress

WHA National Collaborative

Improving outcomes for women through reducing avoidable third and forth degree perineal tears

Teams who signed up to participate in the Collaborative have been receiving regular support by an Improvement Advisor and the Director of Collaboratives since November 2017.  Teams have been taught a quality improvement curriculum and have been supported by trained improvement advisors which has allowed them to use quality improvement methodology to create reliable systems resulting in improvement in outcomes for women.  At the commencement of the Collaborative Hospital teams submitted baseline sample data, which demonstrated a third and fourth degree tear rate of 6.4% in participating services.  It also demonstrated that compliance with the bundle of interventions was 17%.  Meaning that only 17% of women received all components of the bundle of interventions when indicated. The bundle item most often not provided reliably was the application of a warm compress at perineal stretching.

There has been a decrease of 25% in the total number of third and fourth degree tears within four months of the commencement of the ‘action’ phase of the Collaborative.   The greatest impact has been in women having a spontaneous vaginal delivery where there has been a decrease of 30%.  

Participating teams are continuing to be supported to sustain the gains made and improve processes where necessary.  Teams will continue to be coached on a monthly basis by their dedicated improvement advisor and the Director of Collaboratives. Strategies to support teams beyond the end of the Collaborative are also being planned. 

An evaluation framework has been drafted to facilitate a structured approach to collating all of the quantitative and qualitative data associated with the project.  It is proposed that this framework will guide the preparation of a publication for peer review, together with a public project report. This report will help to inform such services about what, why and how the Collaborative achieved the results that are evident by the end of December.  It is envisaged that the final Collaborative evaluation will be completed by May 2019.


WHA Safety and Quality Meeting 

Time has been allocated in the November WHA Quality and Safety Forum to provide an update on progress in the Collaborative and for participating teams to present their improvement work to a national audience.  Details about the Forum, including how to register is available here