Implementing an Obstetric Hemorrhage Initiative in an Obstetrics and Gynecology Residency Program [343

Abstract

INTRODUCTION: Obstetric hemorrhage is the leading cause of preventable maternal mortality worldwide. Between 1994 and 2004, the United States saw a 27.5% increase in maternal deaths and a 92% increase in maternal blood transfusions resulting from hemorrhage. Early recognition of hemorrhage is vital to reducing maternal morbidity. Reports of formal residency campaigns to reduce hemorrhage and educate residents are sparse. The objective of this project was to implement an obstetric hemorrhage initiative in an obstetrics and gynecology residency program. METHODS: From January 2014 to July 2014, the initiative was introduced in a multidisciplinary, collaborative fashion. Champion leads were identified to form an implementation committee from hospital administration, attending physicians, residents, nursing staff, the quality care department, blood bank, and anesthesia. The following were implemented as part of the initiative: formal hemorrhage data tracking system, obstetric massive transfusion protocol, obstetric hemorrhage cart, hemorrhage risk assessment sticker for all obstetric patients, weight-based blood loss quantification system, postevent debriefing, and active management of the third stage of labor. RESULTS: Over a 7-month period, 16 residents were successfully in-serviced on the key introductory obstetric hemorrhage initiative elements, in conjunction with American College of Obstetricians and Gynecologists district XII and the Florida Perinatal Quality Collaborative. In-service was performed through formal lectures and simulation sessions. Barriers to implementation were few. IMPLICATION: With the initial implementation phase complete, residents and staff report increased awareness of and better confidence to deal with peripartum hemorrhage. Data collection continues, with opportunities to track, quantify, and improve our program's maternal hemorrhage over the coming academic year.