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. 2024 Jun;41(8):1008-1018.
doi: 10.1055/s-0042-1749664. Epub 2022 Jul 10.

Implementation and Outcomes of a Model of Care for Placenta Accreta Spectrum in a Community-Based Private Practice

William Wagner  1 , Matthew Loichinger  1 , Abbey C Sidebottom  2 , Whitney L Wunderlich  2 , Marc Vacquier  2 , Theresa Jentink  1 , Marijo N Aguilera  3 , Sureshbabu N Ahanya  1 , Elizabeth Morgan  4 , Meiling Parker  3 , Donald D Wothe  3
Affiliations

Implementation and Outcomes of a Model of Care for Placenta Accreta Spectrum in a Community-Based Private Practice

William Wagner et al. Am J Perinatol. 2024 Jun.

Abstract

Objective: The aim of the study is to describe a model of care and outcomes for placenta accreta spectrum (PAS) implemented in the context of a community based non-academic health system.

Study design: The program for management of PAS includes a multidisciplinary team approach with protocols for ultrasound assessment, diagnosis, and surgery. The program was implemented in the two largest private hospitals in the Twin Cities, Minnesota, United States. Maternal and fetal outcomes as well as cost were compared for histopathologic confirmed PAS cases before (2007-2014, n = 41) and after (2015-2017, n = 26) implementation of the PAS program.

Results: Implementation of the PAS program was associated with ICU admission reductions from 53.7 to 19.2%, p = 0.005; a decrease of 1,682 mL in mean estimated blood loss (EBL) (p = 0.061); a decrease in transfusion from 85.4 to 53.9% (p = 0.005). The PAS program also resulted in a (non-significant) decrease in both surgical complications from 48.8 to 38.5% (p = 0.408) and postoperative complications from 61.0 to 42.3% (p = 0.135). The total cost of care for PAS cases in the 3 years after implementation of the program decreased by 33%.

Conclusion: The implementation of a model of care for PAS led by a perinatology practice at a large regional non-academic referral center resulted in reductions of ICU admissions, operating time, transfusion, selected surgical complications, overall postoperative complications, and cost.

Key points: · Implementation of a PAS care model resulted in reduced ICU admissions from 53.7% to 19.2%.. · Patient safety increased by reducing blood loss, transfusions and postoperative complications.. · This model decreased operating time, as well as total cost of care by 33%..

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Fig. 1
Fig. 1
Study sample identification process.
Fig. A1
Fig. A1
Standardized operating room management.
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