Rapid-response plan curbs maternal hemorrhage: management strategies include use of ultrasounds, vitamins, and faster availability of blood products.(Obstetrics)

When a second woman died from complications of maternal hemorrhage at his hospital between 2000 and 2001, Isaac P. Lowenwirt, M.D., knew that an institutional approach to systemic change was necessary to provide a safety net.

"When we had two maternal deaths that were secondary to hemorrhage-related complications, we sat down and used a multi-disciplinary approach to develop detailed guidelines to help manage these cases and improve outcomes," said Dr. Lowenwirt of the New York Hospital Queens. The hospital implemented the guidelines in 2001 and has had no maternal deaths since that time.

The New York Hospital Queens is a 439-bed hospital in Flushing, New York, affiliated with the Weill Medical College of Cornell University and the New York Presbyterian Hospital. It is designated as a level III neonatal intensive care center and serves an urban population, including many with Medicaid or other publicly funded insurance. The hospital handles about 3,500 deliveries a year, approximately 1,000 of which are cesarean deliveries.

Dr. Lowenwirt and his colleague Daniel W. Skupski, M.D., director of maternal-fetal medicine, were part of a multi-disciplinary task force that included personnel from the divisions of maternal-fetal medicine, obstetric anesthesiology, neonatology, and the blood bank, as well as the departments of nursing, administration, and communications. The trauma team and operating room staff also helped shape the protocols.

The task force designed a multifaceted approach that included the following:

* Development of a rapid-response program, called Team Blue, based on the team approach used for cardiac arrest patients, with quarterly mock drills conducted on all shifts for various obstetric emergency clinical scenarios.

* Development of clinical pathways, guidelines, and protocols designed to provide for early diagnosis of patients at risk for major obstetric hemorrhage and for streamlined care in emergency situations.