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A Survey of Postpartum Hemorrhage Preparedness in New Jersey and Georgia Hospitals
Abstract Number: S-17
Abstract Type: Original Research
Background: Postpartum hemorrhage (PPH) is a leading cause of preventable maternal morbidity and mortality. A recent survey of academic medical centers suggested that approximately one-third of hospitals do not have a PPH protocol in place. There are no published studies, to our knowledge, that have assessed in a multi-state sample the presence or absence of the full range of elements that comprise PPH preparedness.
Methods: 38 elements essential to PPH preparedness were defined by an expert panel convened by the Association of Women’s Health, Obstetric and Neonatal Nurses that included nurses, an obstetrician, an anesthesiologist, a blood bank director, and a biostatistician. Key informants from all hospitals performing deliveries in states of Georgia and New Jersey were surveyed electronically to determine which elements of preparedness were available at their hospital. A linear regression model was created to identify hospital-level predictors of the number of hemorrhage preparedness elements that were in place.
Results: Of the 136 hospitals contacted, 95 hospitals (70%) submitted completed surveys. The mean number of the 38 preparedness elements present in New Jersey hospitals was 23.9 and in Georgia hospitals was 22.5. Only 2 of the elements (misoprostol and carboprost) were reported to be available at 100% of the hospitals. Of the remaining 36 elements, 4 (methylergonovine maleate, uterine balloon tamponade, blood warmer, and fluid warmer/fluid warmer cabinet) were reported to be available at >90% of the hospitals. Many elements of PPH preparedness were not consistently present. For example, a PPH risk assessment on admission was reported to be routine in only 45 (47.4%) of the hospitals. Only 39 (41.1%) of hospitals reported having a massive transfusion protocol. Simulation drills were performed in only 55 (57.9%) of hospitals. B-Lynch sutures were reported to be available in only 53 (55.5%) hospitals. None of the hospital characteristics assessed, including delivery volume, Cesarean rate, teaching status, or hospital profit status, were independently associated with the number of preparedness elements.
Conclusion: Many elements associated with PPH preparedness are not present in hospitals in these two states. Quality improvement initiatives should focus on ensuring hospitals have the resources, staff, and protocols in place that will facilitate rapid and appropriate responses to PPH events.
 Anesth Analg. 2014 Oct;119(4):906-10