A Quality-Improvement Project to Improve Diagnosis and Management of Chorioamnionitis on Labor and Delivery [A274]. (May 2022)

• Record Type: Journal Article
• Authors: Neuhoff, Barbara K.; Wells, Joshua; Tufton, Anne; Heath, Maya; Olister, Staci; Holman, Stacey L.
• Is Part Of: Obstetrics and gynecology. Volume 139(2022)Supplement 1
• Page Start: 79S
• Page End: 79S
• Publication Date: 2022-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000825656.64979.86
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Chorioamnionitis is an intraamniotic infection and inflammation that is associated with significant neonatal and maternal morbidity. However, diagnostic criteria can vary greatly among providers, leading to unnecessary antibiotic administration and interventions in the mother and neonate. An interdisciplinary quality-improvement team sought to standardize diagnostic criteria for chorioamnionitis on labor and delivery. Previous analysis identified that 60% of chorioamnionitis diagnoses at our institution did not meet ACOG diagnostic guidelines. METHODS: The following interventions were implemented: 1) dissemination of data regarding over-diagnosis and treatment, 2) department-wide educational sessions, and 3) publication of diagnostic guidelines at work stations and on a hospital shared drive. After IRB approval, a before-and-after retrospective cohort study was carried out from 4/1/2018 to 9/30/2021 (intervention: 11/2019) to determine the interventions' impact on compliance with recommended ACOG-supported diagnosis and management of chorioamnionitis. Relevant morbidity rates for patients and neonates with an ICD-9/10 code related to peripartum infections were also analyzed. RESULTS: Patients received the diagnosis of chorioamnionitis significantly less frequently after interventions (pre: 145 of 4, 515, 3.21% of deliveries; post: 101 of 5, 085, 1.99% of deliveries, P <.0002). The incidence of charted diagnoses that did not meet ACOG criteria significantly decreased after interventions (55.86–28.71%, P <.0001). The differences in maternal endometritis as well as maternal and neonatal sepsis were not statistically significant in the pre- and post-intervention groups ( P <.0501, P <.1548, P <.0933). CONCLUSION: Guideline-based diagnosis of chorioamnionitis can be successfully implemented on labor and delivery, leading to less antibiotic use and fewer maternal and neonatal interventions. Implementation was also completed without an increase in maternal or neonatal morbidity.