///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-05:00

Hemorrhage Cart: How much time is saved in a critical scenario?

Abstract Number: F-05
Abstract Type: Original Research

Elsje Harker MD1 ; Paola Pesantes MD2; Katherine St. Romain MD3

BACKGROUND:

Postpartum hemorrhage (PPH) is a leading cause of obstetric morbidity and mortality, affecting 2.9% of women giving birth in the U.S. in 2006 (1). Studies show that a protocol-based approach to PPH decreases morbidity (2). The national partnership for maternal safety developed protocol safety bundles with four domains: Readiness, Recognition and Prevention, Response, and Reporting and System Learning (3). One component of readiness is a cart with standard hemorrhage management supplies. On our L&D floor, supplies needed in a hemorrhage scenario are located in several places. Our aim was to create a hemorrhage cart as part of a developing PPH protocol.

METHODS:

We observed residents with OB anesthesia experience in a postpartum simulation scenario. We asked them to gather a list of supplies needed to manage a hemorrhage and to bring the supplies to the patient’s room as quickly as possible. The residents were allowed to collect supplies from any area of the L&D floor. The end measures were time to completion of task (seconds) and percent completion (percent of supplies collected out of total supplies requested). A survey was completed by participants to gauge prior experience with hemorrhage cases on L&D, to determine why certain supplies were not found, and to assess if a cart would have been helpful. We then created a cart containing standard supplies commonly used for managing a hemorrhage. The same residents were asked to undergo the same simulation after a brief introduction to the hemorrhage cart, and a post intervention survey was conducted, this time asking if the hemorrhage cart had been helpful.

RESULTS:

We used paired t-test to evaluate time differences between the 2 cohorts. The average time to completion in the pre-intervention group was 295.7 seconds longer than the post-intervention group (p<0.001). The ability to find all of the supplies in the two groups was analyzed using a 2-proportion test. In the pre-intervention group 29% of residents found 100% of supplies vs 100% in the post-intervention group (p<0.001). Our pre-intervention survey showed that the most common cause of failure to find supplies was lack of knowledge of where supplies were located (several locations). 65% of residents reported experience with a stressful hemorrhage case and all agreed that a hemorrhage cart would be helpful. Our post-intervention data showed 100% success and 100% of residents stated the cart was helpful in managing the scenario.

CONCLUSION:

While it is obvious that keeping supplies in one location would reduce time needed to gather supplies, the reduction in time in our simulated scenario was nearly 5 minutes. As part of a multi-step approach to PPH management, a cart can significantly improve efficient patient care in cases where early intervention can decrease morbidity and mortality.

1. Callaghan. Am J Obstet Gynecol 2010;202:353 e1-6.

2. Shields. Am J Obstet Gynecol 2015;212:272-80.

3. Main. Anesth Analg 2015;121:142-8.

SOAP 2017