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OBstetric Emergency Team (OBET) Response System: Activation Triggers and Location of Request Origination
Abstract Number: F 26
Abstract Type: Original Research
Background: An OBET response system was introduced on a busy tertiary, maternal care unit in April 2010, with a goal of timely recruitment of inter-professional personnel skilled in managing rapidly evolving high-stakes OB emergencies.1,2 We recorded medical indications triggering OBET activation, and the location of origin of emergency assistance requests during its 33 month history.
Methods: IRB approval. Obstetric quality database and call records were used to classify all OBET activations, from April 2010 (month of implementation) to December 2012, according to triggering medical condition & location of origination.
Results: OBET was activated 455 times. Fetal heart rate (FHR) concerns were the leading trigger (279 calls, 61.3%). Other triggers included precipitous, imminent, or outborn deliveries (68, 14.9%), postpartum hemorrhage (48, 10.5%), trauma (18, 4.0%), cord prolapse (14, 3.1%), maternal cardiopulmonary problems (9, 2.0%), antepartum bleeding (6, 1.3%), shoulder dystocia (6, 1.3%), uterine rupture (3, 0.7%), seizure (3, 0.7%), labor in emergency department (ED) (4, 0.9%), abruption (2, 0.4%), breech & complete cervical dilation (2, 0.4%), hypoglycemic neonate (2, 0.4%), and ruptured ectopic (1, 0.2%). There were ten (2.2%) OBET calls that were duplicate activations, and 11 (2.4%) that had unknown triggers.
Not surprisingly, L&D was the most common activation location of origin (248 activations, 61.3%). Nearby maternal care areas included the ante-/post-partum floor (53, 11.6%), maternal special care & triage area (34, 7.5%), and obstetric overflow area (3, 0.7%). There were 77 OBET activations (16.9%) originating in the ED, two (0.4%) in the children’s hospital ED, and 7 (1.5%) in various medical center locations (e.g. lobby, elevator, garage, ICUs, OR).
Discussion: Review of data on triggers & location of origination are helpful in assessing the health of a rapid response system. Results are consistent with the goal of responsiveness to the unique needs of parturients. Specific indications correlate with clinical quality improvement initiatives. Increases in PPH and FHR indications reflect vigorous efforts to encourage earlier summoning of response personnel to improve outcomes. The subsequent decline in PPH as a trigger mirrors collaborative practice changes that significantly reduced the incidence of PPH on our unit.
Ref: 1) Grosman GG, et al. Am J Obstet Gynecol 2008;198:367.e1-7. 2) Skupski DW, et al. Obstet Gynecol 2006;107:977-83.