Impact on Patient Outcomes of Implementation of Ob Hemorrhage Safety Bundle with Multidisciplinary Simulations
ACOG ePoster. Binkley S. Apr 27, 2018; 211557; 16J
Shelley Binkley
Shelley Binkley
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Abstract
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Introduction: Beaumont Hospital Dearborn Labor and Delivery unit serves a diverse population of pregnant patients, delivering 4000-4500 women annually. Approximately 40% are diagnosed as 'high risk' based on medical or obstetric criteria. In 2016, we implemented a national (ACOG / SMFM) Obstetric hemorrhage safety bundle at Dearborn. Obstetric hemorrhage was defined as quantitative or estimated blood loss of 500 mL or greater, during the patient's delivery stay. We performed educational presentations to all obstetric nurses, obstetric and anesthesia physicians, CRNAs, CNMs, physician assistants and residents, as well as conducted sixteen multi-disciplinary simulations over three months to implement the safety bundle. These simulations took place from June 1 through August 31, 2016 and involved physically going through an obstetric hemorrhage scenario on labor and delivery complete with model patients, simulated blood, hemorrhage cart, and all instruments and supplies needed to conduct a hemorrhage response. All participants took a required on-line course post-test on the information presented after they completed the simulation.

Methods: This abstract represents Phase One of a two-phase study. The methods of both phases are presented here for the sake of completion.
Phase One of the project evaluates the overall rates of obstetric hemorrhage diagnosed, the numbers of cases transfused, and the number of blood products used. This phase does not use identifiable patient data. The endpoint for Phase One is determination of the rates of diagnosis of postpartum hemorrhage and the rates of transfusion and blood products used expressed as percentages of deliveries.

Phase Two of the project evaluates in detail all patients diagnosed with obstetric hemorrhage to assess interventions. This phase is a retrospective chart review that will involve examination of patients diagnosed with hemorrhage and de-identified patient data. The interventions include quantitative measurement of blood loss, administration of uterotonics, transfusion of blood products, and surgical interventions (e.g. insertion of Bakri Balloon, uterine curettage, laparotomy, use of uterine compressions sutures, ligation of hypogastric artery, and cesarean hysterectomy). This phase will study admission and discharge hemoglobin values, as well as rates of the above-stated interventions to assess the character and quality of the institution's r
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