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

INTRODUCTION AND HYPOTHESIS: As 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. METHODS: This 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. RESULTS: There 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.