The OASI care bundle quality improvement project: lessons learned and future direction

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Abstract

Rising rates of obstetric anal sphincter injury (OASI) led to a collaborative effort by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) to develop and evaluate the OASI Care Bundle (OASI-CB). The OASI-CB comprises four practices (antenatal discussion about OASI, manual perineal protection, mediolateral episiotomy at 60° from the midline, and systematic examination of the perineum, vagina and ano-rectum after vaginal birth) and was initially implemented as part of a quality improvement (QI) project—“OASI1”—in 16 maternity units across Great Britain. Evaluation of the OASI1 project found that the care bundle reduced OASI rates and identified several barriers and enablers to implementation. This paper summarises the key findings, including strengths, limitations and lessons learned from the OASI1 QI project, and provides rationale for further evaluation of the OASI-CB.

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Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.

Geoffrey M Curran, Mark Bauer, Brian Mittman … (2012)

This study proposes methods for blending design components of clinical effectiveness and implementation research. Such blending can provide benefits over pursuing these lines of research independently; for example, more rapid translational gains, more effective implementation strategies, and more useful information for decision makers. This study proposes a "hybrid effectiveness-implementation" typology, describes a rationale for their use, outlines the design decisions that must be faced, and provides several real-world examples. An effectiveness-implementation hybrid design is one that takes a dual focus a priori in assessing clinical effectiveness and implementation. We propose 3 hybrid types: (1) testing effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation; (2) dual testing of clinical and implementation interventions/strategies; and (3) testing of an implementation strategy while observing and gathering information on the clinical intervention's impact on relevant outcomes. The hybrid typology proposed herein must be considered a construct still in evolution. Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.

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The stepped wedge cluster randomised trial: rationale, design, analysis, and reporting

K Hemming, T P Haines, P J Chilton … (2015)

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The concept of scalability: increasing the scale and potential adoption of health promotion interventions into policy and practice.

Sally Redman, Lesley King, Adrian E. Bauman … (2013)

Increased focus on prevention presents health promoters with new opportunities and challenges. In this context, the study of factors influencing policy-maker decisions to scale up health promotion interventions from small projects or controlled trials to wider state, national or international roll-out is increasingly important. This study aimed to: (i) examine the perspectives of senior researchers and policy-makers regarding concepts of 'scaling up' and 'scalability'; (ii) generate an agreed definition of 'scalability' and (iii) identify intervention and research design factors perceived to increase the potential for interventions to be implemented on a more widespread basis or 'scaled up'. A two-stage Delphi process with an expert panel of senior Australian public health intervention researchers (n = 7) and policy-makers (n = 7) and a review of relevant literature were conducted. Through this process 'scalability' was defined as: the ability of a health intervention shown to be efficacious on a small scale and or under controlled conditions to be expanded under real world conditions to reach a greater proportion of the eligible population, while retaining effectiveness. Results showed that in health promotion research insufficient attention is given to issues of effectiveness, reach and adoption; human, technical and organizational resources; costs; intervention delivery; contextual factors and appropriate evaluation approaches. If these issues were addressed in the funding, design and reporting of intervention research, it would advance the quality and usability of research for policy-makers and by doing so improve uptake and expansion of promising programs into practice.

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Author and article information

Contributors

Magdalena Jurczuk:

ORCID: http://orcid.org/0000-0001-6915-767X

mjurczuk@rcog.org.uk

Nick Sevdalis: nick.sevdalis@kcl.ac.uk

Journal

Journal ID (nlm-ta): Int Urogynecol J

Journal ID (iso-abbrev): Int Urogynecol J

Title: International Urogynecology Journal

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0937-3462

ISSN (Electronic): 1433-3023

Publication date (Electronic): 14 May 2021

Publication date PMC-release: 14 May 2021

Publication date (Print): 2021

Volume: 32

Issue: 7

Pages: 1989-1995

Affiliations

[1 ]GRID grid.464668.e, ISNI 0000 0001 2167 7289, Centre for Quality Improvement and Clinical Audit, , Royal College of Obstetricians and Gynaecologists, ; 10–18 Union Street, London, SE1 1SZ UK

[2 ]GRID grid.8991.9, ISNI 0000 0004 0425 469X, Department of Health Services Research and Policy, , London School of Hygiene and Tropical Medicine, ; 15–17 Tavistock Place, London, WC1H 9SH UK

[3 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, Centre for Implementation Science, Health Service and Population Research Department, , King’s College London, ; De Crespigny Park, London, SE5 8AF UK

[4 ]GRID grid.467531.2, ISNI 0000 0004 0490 340X, Royal College of Midwives, ; 10–18 Union Street, London, SE1 1SZ UK

[5 ]Croydon University Hospitals NHS Trust, 530 London Road, Croydon, CR7 7YE UK

Author information

Magdalena Jurczuk http://orcid.org/0000-0001-6915-767X

Article

Publisher ID: 4786

DOI: 10.1007/s00192-021-04786-y

PMC ID: 8295109

PubMed ID: 33988784

SO-VID: 13341cf0-65a2-48f3-8338-dc30b6930560

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 20 January 2021

Date accepted : 24 March 2021

Funding

Funded by: Health Foundation

Award ID: 7674

Award ID: 1274142

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: oasi care bundle,obstetric anal sphincter injury,severe perineal tear,scale-up,quality improvement,implementation

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: oasi care bundle, obstetric anal sphincter injury, severe perineal tear, scale-up, quality improvement, implementation

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The OASI care bundle quality improvement project: lessons learned and future direction

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Abstract

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Advocacy for Maternal and Women’s Health

Most cited references 19

Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.

The stepped wedge cluster randomised trial: rationale, design, analysis, and reporting

The concept of scalability: increasing the scale and potential adoption of health promotion interventions into policy and practice.

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Cited by 9

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