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Hemorrhage Cart: How much time is saved in a critical scenario?
Abstract Number: F-05
Abstract Type: Original Research
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.
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.
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.
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.