Dena Goffman1, Cande V Ananth1,2, Adiel Fleischer3,4, Mary D'Alton1, Jessica A Lavery1, Richard Smiley5, Kristin Zielinski6, Cynthia Chazotte7. 1. Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York. 2. Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York. 3. Department of Obstetrics and Gynecology, North Shore University Hospital, Manhasset, New York. 4. Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, New Hyde Park, New York. 5. Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York. 6. The American College of Obstetricians and Gynecologists (ACOG), District II, Albany, New York. 7. Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Abstract
OBJECTIVE: To determine the effects of the Safe Motherhood Initiative's (SMI) obstetric hemorrhage bundle in New York State (NYS). STUDY DESIGN: In 2013, the SMI convened interprofessional workgroups on hemorrhage, venous thromboembolism, and hypertension tasked with developing evidence-based care bundles. Participating hospitals submitted data measured before, during, and after implementation of the hemorrhage bundle: maternal mortality, intensive care unit (ICU) admission, cardiovascular collapse, hysterectomy, and transfusion of ≥4 units of red blood cells (RBCs). Data were analyzed for trends stratified by implementation status. RESULTS: Of the 123 maternity hospitals in NYS, 117 participated, of which 113 submitted data. Of 250,719 births, transfusion of ≥4 units RBCs (1.8 per 1,000) and ICU admissions (1.1 per 1,000) were the most common morbidities. Four hemorrhage-related maternal deaths (1.6 per 100,000) and 10 cases of cardiovascular collapse requiring cardiopulmonary resuscitation (4.0 per 100,000) occurred. Hemorrhage morbidity did not change over the five quarters studied. Risks were similar across hospital level of care and implementation status. CONCLUSION: Statewide implementation of bundles is feasible with resources critical to success. The low hemorrhage-related maternal death rate makes changes in mortality risk difficult to detect over short time intervals. Long-term and timely data collection with individual expert case review will be required. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
OBJECTIVE: To determine the effects of the Safe Motherhood Initiative's (SMI) obstetric hemorrhage bundle in New York State (NYS). STUDY DESIGN: In 2013, the SMI convened interprofessional workgroups on hemorrhage, venous thromboembolism, and hypertension tasked with developing evidence-based care bundles. Participating hospitals submitted data measured before, during, and after implementation of the hemorrhage bundle: maternal mortality, intensive care unit (ICU) admission, cardiovascular collapse, hysterectomy, and transfusion of ≥4 units of red blood cells (RBCs). Data were analyzed for trends stratified by implementation status. RESULTS: Of the 123 maternity hospitals in NYS, 117 participated, of which 113 submitted data. Of 250,719 births, transfusion of ≥4 units RBCs (1.8 per 1,000) and ICU admissions (1.1 per 1,000) were the most common morbidities. Four hemorrhage-related maternal deaths (1.6 per 100,000) and 10 cases of cardiovascular collapse requiring cardiopulmonary resuscitation (4.0 per 100,000) occurred. Hemorrhage morbidity did not change over the five quarters studied. Risks were similar across hospital level of care and implementation status. CONCLUSION: Statewide implementation of bundles is feasible with resources critical to success. The low hemorrhage-related maternal death rate makes changes in mortality risk difficult to detect over short time intervals. Long-term and timely data collection with individual expert case review will be required. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Authors: Mary E D'Alton; Kara M Rood; Marcela C Smid; Hyagriv N Simhan; Daniel W Skupski; Akila Subramaniam; Kelly S Gibson; Todd Rosen; Shannon M Clark; Donald Dudley; Sara N Iqbal; Michael J Paglia; Christina M Duzyj; Edward K Chien; Karen J Gibbins; Kathryn D Wine; Nana Ama A Bentum; Michelle A Kominiarek; Methodius G Tuuli; Dena Goffman Journal: Obstet Gynecol Date: 2020-11 Impact factor: 7.623