title: Comprehensive maternal hemorrhage protocols improve patient safety and reduce utilization of blood products.
abstract: OBJECTIVE
  The purpose of this study was to assess the effectiveness of instituting a comprehensive protocol for the treatment of maternal hemorrhage.
  
  
  METHODS
  The protocol was separated into 4 stages, designated 0-3, based on the degree of blood loss and the patient response to interventions. Key components included admission risk assessment, measurement of blood loss, early but limited use of uterotonic agents, early presence of obstetrical and anesthesia staff, and transfusion with fixed ratios of blood products. Data were collected retrospectively and prospectively relative to the start of the protocol.
  
  
  RESULTS
  We noted a significant shift toward resolution of maternal bleeding at an earlier stage (P < .01), use of fewer blood products (P < .01), and a 64% reduction in the rate of disseminated intravascular coagulation. In addition, there were significant improvements in staff and physician perceptions of patient safety (P < .01).
  
  
  CONCLUSIONS
  Comprehensive maternal hemorrhage treatment protocols improve patient safety and reduce utilization of blood products.
authors.affiliation: Department of Obstetrics and Gynecology, Marian Medical Center, Santa Maria, CA, USA.
authors.forename: Laurence E
authors.initials: LE
authors.lastname: Shields
authors.forename: Kathy
authors.initials: K
authors.lastname: Smalarz
authors.forename: Lester
authors.initials: L
authors.lastname: Reffigee
authors.forename: Sandra
authors.initials: S
authors.lastname: Mugg
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Burdumy
authors.forename: Marilyn
authors.initials: M
authors.lastname: Propst
mesh_terms: D000465:Algorithms; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D003191:Comprehensive Health Care; D005260:Female; D006801:Humans; D061214:Patient Safety; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index