A quality improvement and educational initiative to reduce morbidity associated with massive postpartum hemorrhage
Bibliographic record
Abstract
OBJECTIVE: To determine the effect of a quality improvement and educational initiative on blood transfusion rates and patient morbidity from massive postpartum hemorrhage. METHODS: A retrospective chart review was performed of massive postpartum hemorrhage (mPPH) at an urban tertiary care center. Inclusion criteria are women with mPPH over 20 weeks gestational age. The primary outcome was the number of packed red blood cell (pRBC) transfusions required. Two time periods were compared-the control period (January 2006-December 2011), and the educational period (January 2012-December 2015) by calculating an incidence rate ratio using Poisson regression. RESULTS: Among 189 women with mPPH, 107 cases occurred during the control period and 82 during the educational period. In the educational period, there were 13% (95% confidence interval [CI] 2%-23%) fewer pRBC and 16% (95% CI 1%-29%) fewer fresh frozen plasma (FFP) units transfused compared with the control period. There was a decrease of 58 minutes (95% CI -106 to -9.52) of the median time from diagnosis of mPPH to transfusion of FFP. CONCLUSION: The quality improvement educational initiative decreased the number of pRBC and FFP transfusions required, and shortened the latency interval to transfusion of FFP.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.023 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".