title: Comprehensive maternal hemorrhage protocols reduce the use of blood products and improve patient safety.
abstract: The purpose of this study was to assess the effectiveness of instituting a comprehensive protocol for the treatment of maternal hemorrhage within a large health care system. A comprehensive maternal hemorrhage protocol was initiated within a health care system with 29 different delivery units and with >60,000 annual births. Compliance with key elements of the protocol was assessed monthly by a dedicated perinatal safety nurse at each site and validated during site visits by system perinatal nurse specialist. Outcome variables were the total number of units of blood transfused and the number of puerperal hysterectomies. Three time points were assessed: (1) 2 months before implementation of the protocol, (2) a 2-month period that was measured at 5 months after implementation of the protocol, and (3) a 2-month period at 10 months after implementation. There were 32,059 deliveries during the 3 study periods. Relative to baseline, there was a significant reduction in blood product use per 1000 births (-25.9%; P < .01) and a nonsignificant reduction (-14.8%; P = .2) in the number of patients who required puerperal hysterectomy. Within a large health care system, the application of a standardized method to address maternal hemorrhage significantly reduced maternal morbidity, based on the need for maternal transfusion and peripartum hysterectomy. These data support implementation of standardized methods for postpartum care and treatment of maternal hemorrhage and support that this approach will reduce maternal morbidity.
authors.affiliation: Patient Safety, Dignity Health, San Francisco, CA; Maternal Fetal Medicine, Marian Regional Medical Center, Santa Maria, CA. Electronic address: larryshields@me.com.
authors.forename: Laurence E
authors.initials: LE
authors.lastname: Shields
authors.affiliation: Patient Safety, Dignity Health, San Francisco, CA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Wiesner
authors.affiliation: Patient Safety, Dignity Health, San Francisco, CA.
authors.forename: Janet
authors.initials: J
authors.lastname: Fulton
authors.affiliation: Patient Safety, Dignity Health, San Francisco, CA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pelletreau
mesh_terms: D000465:Algorithms; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002985:Clinical Protocols; D003661:Decision Support Techniques; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006489:Hemostatic Techniques / Q000592:standards*; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D061214:Patient Safety; D006473:Postpartum Hemorrhage / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D058996:Quality Improvement; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: maternal hemorrhage; patient safety; transfusion