The Effect of Implementation of a Standardized Multidisciplinary Placenta Accreta Spectrum Team: A Quality Improvement Initiative [ID: 1377806]

Abstract

INTRODUCTION: Placenta accreta spectrum (PAS) is associated with significant morbidity and mortality. A multidisciplinary team and standardized protocol for identified PAS cases were created to provide a clear preoperative plan for mitigation of intraoperative blood loss, and surgical and postoperative complications. METHODS: This is an ongoing quality improvement study. The PAS team was implemented January 2021. All cases of PAS resulting in cesarean hysterectomy from January 2018 through August 2022 at a single regional perinatal center were included. Estimated blood loss (EBL), number of blood products (packed red cells, platelets, fresh frozen plasma), whether surgical complication was incurred, intensive care unit (ICU) length of stay (LOS), and hospital LOS were compared. T tests and χ2 were used to calculate significance. RESULTS: Thirty-eight cases were reviewed, 18 cases before implementation of the PAS team, 20 after. Average EBL was 3,800 mL pre-team, 3,191 mL post-team (P=.522). Pre-team average units of packed red cells were 4.67, 3.55 post-team (P=.199); platelets 1.72 versus 1.35 units (P=.424); fresh frozen plasma 0.67 versus 0.55 units (P=.581). Average ICU LOS and hospital LOS pre-team were 0.67 and 3.56 days, 0.30 (P=.121) and 3.35 (P=.434) days, respectively, post-team. CONCLUSION: Estimated blood loss, total blood products, occurrence of surgical complication, ICU LOS, and hospital LOS were decreased after implementation of a PAS multidisciplinary team. Statistical insignificance in all parameters was attributable to small sample size necessitating further future analysis with additional cases. A standardized multidisciplinary approach to PAS may demonstrate morbidity reduction.