@article {Rasmussenu217936.w7106, author = {Ole Bredahl Rasmussen and Annika Yding and Jacob Anh{\o}j and Charlotte Sander Andersen and Jane Boris}, title = {Reducing the incidence of Obstetric Sphincter Injuries using a hands-on technique: an interventional quality improvement project}, volume = {5}, number = {1}, elocation-id = {u217936.w7106}, year = {2016}, doi = {10.1136/bmjquality.u217936.w7106}, publisher = {BMJ Open Quality}, abstract = {A main concern for women giving birth is the risk of obstetric anal sphincter injuries. In our department the incidence of sphincter injuries was around 8 \% among vaginally delivering first time mothers. We aimed to halve the incidence to 4 \% or less. A prospective interventional program was instituted. We implemented a hands-on technique with four elements in a bundle of care together with a certification process for all staff on the delivery ward. The incidence of episiotomies served as a balancing indicator.The adherence to three of the four elements of the care bundle rose significantly while the all-or-nothing indicator leveled around 80 \%. The median number of deliveries between cases with a sphincter injury increased from 9.5 in the baseline period to 20 during the intervention period. This corresponded with a reduction in the incidence from 7.0 \% to 3.4 \%. The rate of episiotomy remained low at 8.4 \% in this group. By implementing the hands-on technique, we halved the risk of obstetric anal sphincter injuries. Our data suggest that further improvement may be anticipated. The study has demonstrated how implementation of a hands-on technique can be carried out within a quality improvement framework with rapid and sustainable results.}, URL = {https://bmjopenquality.bmj.com/content/5/1/u217936.w7106}, eprint = {https://bmjopenquality.bmj.com/content/5/1/u217936.w7106.full.pdf}, journal = {BMJ Open Quality} }