(1088) Single Institution Implementation of a Stillbirth Evaluation Quality Improvement Initiative

Objective: The relative infrequency of stillbirths and lack of uniform protocols leads to inconsistency in providing an optimal, cost-effective evaluation. We implemented a quality improvement (QI) initiative to standardize and optimize stillbirth evaluation.

Study Design: Two phase QI initiative targeting stillbirth evaluation at a single academic center between 1/2018 and 7/2023. Phase 1 was a cohort study evaluating the proportion of optimal stillbirth evaluations before and after the publication of the ACOG/SMFM Obstetric Care Consensus (OCC) in 3/2020. Phase 2 involved presentation of findings to faculty and residents at our Annual Research Symposium in 6/2022. Publication of a hospital specific stillbirth protocol followed in 11/2022. Stillbirths included were singleton, non-anomalous fetuses > 20 weeks gestation or > 350 grams. Severe anomalies, spontaneously ruptured membranes, and stillbirths diagnosed intrapartum were excluded. Primary outcome was optimal stillbirth evaluation, defined as placental pathology, counseling on genetic testing & autopsy, and antiphospholipid syndrome testing. Secondary outcome examined unnecessary testing (infectious titers and/or inherited thrombophilia work up). Analysis was performed using student’s t test and chi square test.

Results: There were 41 total stillbirths divided into three groups, with 26 stillbirths occurring in the pre-OCC group, 11 occurring in the post-OCC group, and 4 stillbirths occurring in the post-protocol group. Washout periods were observed following the OCC publication and from presentation of phase 1 to publication of the site wide protocol. The post-protocol group had a higher maternal age at delivery; there were no other differences between the three groups. We observed a stepwise improvement in the optimal stillbirth evaluation over time (15.4% vs 72.7% vs 100%, p=< 0.01, figure 1). Likewise, we saw a decline in unnecessary test performance over time (61.5% vs 0% vs 0%, p=< 0.01).

Conclusion: Our quality improvement initiative resulted in 100% compliance with optimal stillbirth evaluation and a reduction in unnecessary testing.