Evaluating Hospital Hemorrhage Protocol Components and Maternal Morbidity
ACOG ePoster. Srinivas S.
Apr 27, 2018; 211933
Sindhu Srinivas
Sindhu Srinivas
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Abstract
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Introduction: The Council for Patient Safety in Women's Health suggested implementation of a hemorrhage bundle to reduce obstetrical hemorrhage and improve related morbidity. We previously reported that approximately 20% of the variation in hospital postpartum hemorrhage (PPH) frequency was related to provider/hospital factors. We aim to assess whether the number of recommended components included in a hospital's obstetrical hemorrhage protocol reduces maternal morbidity.

Methods: A total of 14,283 women who delivered at 4 hospitals with hemorrhage protocols between March 2008 and February 2011 were analyzed. Two hospitals updated their protocol during the study period resulting in evaluation of 6 protocols, with analyses being performed based on the protocol in place at the time of delivery. Each protocol was evaluated by two independent reviewers to assess for the presence of 14 components, as recommended by the Council for Patient Safety in Women's Health. Disagreements were adjudicated by a third reviewer, masked to prior determinations. The primary outcome was a composite hemorrhage outcome including transfusion, blood loss1000 cc, or hysterectomy. Hierarchical models were adjusted for multiple confounders.

Results: The number of elements present ranged from 1 to 7 per protocol. Nearly all protocols (83%) included a hemorrhage risk assessment and checklist for hemorrhage management. None of the protocols reported existence of a hemorrhage cart or specified the structure of reporting or debriefing. There was no association between the number of protocol elements present and the composite hemorrhage outcome (aOR 1.09; 95%CI 0.80-1.48).




Conclusion/Implications: Among the hemorrhage protocols evaluated, only 1 had at least half of the suggested elements. Further evaluation is needed to determine the association of adverse outcomes with these protocols, and which elements are truly key factors in reducing maternal morbidity.
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