title: Improving hospital systems for the care of women with major obstetric hemorrhage.
abstract: OBJECTIVE
  When 2 maternal deaths due to hemorrhage occurred at New York Hospital Queens in 2000-2001, a multidisciplinary team implemented systemic change. Our objective was to improve outcomes of episodes of major obstetric hemorrhage.
  
  
  METHODS
  We report outcomes before (2000-2001) and after (2002-2005) the introduction of a patient safety program aimed at improving the care of women with major obstetric hemorrhage. Process changes were instituted in late 2001 at the direction of a multidisciplinary patient safety team. A rapid response team was formulated using the cardiac arrest team as a model. Protocols for early diagnosis, assessment, and management of patients at high risk for major obstetric hemorrhage were developed and communicated to staff.
  
  
  RESULTS
  There were significant increases in cesarean births (P < .001), repeat cesarean births (P = .002), and cases of major obstetric hemorrhage (P = .02) between the periods of 2000-2001 and 2002-2005. There was a significant improvement in mortality due to hemorrhage (P = .036), lowest pH (P = .004), and lowest temperature (P < .001) when comparing 2000-2001 with 2002-2005. There were no differences in measures of severity of obstetric hemorrhage between the 2 periods, including Acute Physiology and Chronic Health Evaluation II scores, occurrence of placenta accreta and estimated blood loss.
  
  
  CONCLUSIONS
  Despite a significant increase in major obstetric hemorrhage cases, we found improved outcomes and fewer maternal deaths after implementing systemic approaches to improve patient safety. Attention to improving the hospital systems necessary for the care of women at risk for major obstetric hemorrhage is important in the effort to decrease maternal mortality from hemorrhage.
authors.affiliation: Departments of Obstetrics and Gynecology, Anesthesiology, and Quality Management, New York Hospital Medical Center of Queens, Flushing, New York 11355, USA. dwskupsk@med.cornell.edu
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Skupski
authors.forename: Isaac P
authors.initials: IP
authors.lastname: Lowenwirt
authors.forename: Fredric I
authors.initials: FI
authors.lastname: Weinbaum
authors.forename: Dana
authors.initials: D
authors.lastname: Brodsky
authors.forename: Margaret
authors.initials: M
authors.lastname: Danek
authors.forename: Gary S
authors.initials: GS
authors.lastname: Eglinton
mesh_terms: D000328:Adult; D002585:Cesarean Section; D019091:Critical Pathways / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome