Postpartum Screening and Referral for Pelvic Floor Dysfunction at a United States Military Medical Center.

introduction and hypothesisAs more women serve in physically demanding military roles, they are increasingly vulnerable to pelvic floor dysfunction (PFD). Our aim was to improve the pelvic health of postpartum women by creating a standardized screening and referral program for PFD at a US military medical center.

methodsThis quality improvement project utilized a pre-post design, evaluating data from a historical group and an intervention group. The intervention utilized a standardized screener to assess women for PFD at a 2-week postpartum phone call and a 6-week postpartum clinic visit. The primary outcome was referral rate to pelvic floor physical therapy (PFPT). Additional variables assessed included screening compliance, referral utilization, and provider satisfaction.

resultsThere were 122 postpartum women in the historical group and 181 in the intervention group. The referral rate nearly doubled when comparing the historical and intervention groups (17.2% vs 33.1%, p = 0.002). Referral utilization was also higher in the intervention group (18.2% vs 14.8%, p < 0.001). At the time of the 2-week phone call, screening compliance was 96%, compared with 67% at the 6-week visit. A pre-intervention provider survey indicated that most providers screened for PFD without a standardized screening tool. A post-intervention survey indicated that the implemented screening process helped to direct patient conversations, was feasible, and assisted with identifying dysfunction. DISCUSSION: A universal standardized screening program for PFD in postpartum patients at a US military medical center was significantly associated with increased PFPT referral and utilization. Time was the biggest barrier to screening. Providers were largely supportive and accepting of the screening process.