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Massive hemorrhage protocol activation in obstetrics: a 5-year quality performance review
•Seventeen massive haemorrhage protocol events among 19 790 deliveries (0.09%).•Areas of improvement were consistent laboratory testing and hypothermia monitoring.•Over-transfusion occurred more often than under-transfusion.•The majority of hemorrhages were due to uterine atony and abnormal placenta...
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| Published in: | International journal of obstetric anesthesia 2019-05, Vol.38, p.37-45 |
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| cites | cdi_FETCH-LOGICAL-c356t-6f9cb98533333fef09e96e830755a02cb9cd4328d7946944ebc3813f91754d3e3 |
| container_end_page | 45 |
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| container_title | International journal of obstetric anesthesia |
| container_volume | 38 |
| creator | Margarido, C. Ferns, J. Chin, V. Ribeiro, T. Nascimento, B. Barrett, J. Herer, E. Halpern, S. Andrews, L. Ballatyne, G. Chapmam, M. Gomes, J. Callum, J. |
| description | •Seventeen massive haemorrhage protocol events among 19 790 deliveries (0.09%).•Areas of improvement were consistent laboratory testing and hypothermia monitoring.•Over-transfusion occurred more often than under-transfusion.•The majority of hemorrhages were due to uterine atony and abnormal placentation.•In many cases there was no documentation of a debrief after protocol termination.
A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team.
A multidisciplinary team set the institutional quality indicators for the massive hemorrhage protocol review. A retrospective review of all obstetrical massive hemorrhage protocol activation events from September 2010 to January 2015 was performed. All protocol events occurred before the creation of the quality indicators. Data were retrieved from patient records.
There were 17 (0.09%) protocol activations for 19 790 deliveries during the study period. All 17 (100%) patients received at least one unit of red blood cells. Overactivation, defined as the transfusion of |
| doi_str_mv | 10.1016/j.ijoa.2018.10.004 |
| format | article |
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A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team.
A multidisciplinary team set the institutional quality indicators for the massive hemorrhage protocol review. A retrospective review of all obstetrical massive hemorrhage protocol activation events from September 2010 to January 2015 was performed. All protocol events occurred before the creation of the quality indicators. Data were retrieved from patient records.
There were 17 (0.09%) protocol activations for 19 790 deliveries during the study period. All 17 (100%) patients received at least one unit of red blood cells. Overactivation, defined as the transfusion of <2 units of red blood cells, occurred in two cases (12%). Common causes of non-compliance were: 24% (4/17) temperature monitoring, 18% (3/17) lactate measurement, 41% (7/17) arterial blood gas sampling, and 18% (3/17) hemoglobin maintenance within the target range of 55–95 g/L. Admission to intensive care and peripartum hysterectomy occurred in 12 and 5 cases (71% and 29%), respectively.
Suboptimal compliance was found in multiple areas, which may be attributable to the low frequency of activation of our massive haemorrhage protocol in obstetrics. The quality targets identified in this report can act as a basis for other institutions developing quality indicators to evaluate performance.</description><identifier>ISSN: 0959-289X</identifier><identifier>EISSN: 1532-3374</identifier><identifier>DOI: 10.1016/j.ijoa.2018.10.004</identifier><identifier>PMID: 30509680</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Adult ; Blood transfusion ; Blood Transfusion - methods ; Clinical Protocols ; Delivery, Obstetric ; Female ; Guideline Adherence - statistics & numerical data ; Humans ; Massive hemorrhage protocol ; Massive transfusion protocol ; Obstetric Labor Complications - diagnosis ; Obstetric Labor Complications - therapy ; Postpartum hemorrhage ; Postpartum Hemorrhage - diagnosis ; Postpartum Hemorrhage - therapy ; Pregnancy ; Quality Control ; Quality improvement ; Quality Indicators, Health Care - statistics & numerical data ; Retrospective Studies ; Young Adult</subject><ispartof>International journal of obstetric anesthesia, 2019-05, Vol.38, p.37-45</ispartof><rights>2018</rights><rights>Copyright © 2018. Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-6f9cb98533333fef09e96e830755a02cb9cd4328d7946944ebc3813f91754d3e3</citedby><cites>FETCH-LOGICAL-c356t-6f9cb98533333fef09e96e830755a02cb9cd4328d7946944ebc3813f91754d3e3</cites><orcidid>0000-0002-7480-5122</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30509680$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Margarido, C.</creatorcontrib><creatorcontrib>Ferns, J.</creatorcontrib><creatorcontrib>Chin, V.</creatorcontrib><creatorcontrib>Ribeiro, T.</creatorcontrib><creatorcontrib>Nascimento, B.</creatorcontrib><creatorcontrib>Barrett, J.</creatorcontrib><creatorcontrib>Herer, E.</creatorcontrib><creatorcontrib>Halpern, S.</creatorcontrib><creatorcontrib>Andrews, L.</creatorcontrib><creatorcontrib>Ballatyne, G.</creatorcontrib><creatorcontrib>Chapmam, M.</creatorcontrib><creatorcontrib>Gomes, J.</creatorcontrib><creatorcontrib>Callum, J.</creatorcontrib><title>Massive hemorrhage protocol activation in obstetrics: a 5-year quality performance review</title><title>International journal of obstetric anesthesia</title><addtitle>Int J Obstet Anesth</addtitle><description>•Seventeen massive haemorrhage protocol events among 19 790 deliveries (0.09%).•Areas of improvement were consistent laboratory testing and hypothermia monitoring.•Over-transfusion occurred more often than under-transfusion.•The majority of hemorrhages were due to uterine atony and abnormal placentation.•In many cases there was no documentation of a debrief after protocol termination.
A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team.
A multidisciplinary team set the institutional quality indicators for the massive hemorrhage protocol review. A retrospective review of all obstetrical massive hemorrhage protocol activation events from September 2010 to January 2015 was performed. All protocol events occurred before the creation of the quality indicators. Data were retrieved from patient records.
There were 17 (0.09%) protocol activations for 19 790 deliveries during the study period. All 17 (100%) patients received at least one unit of red blood cells. Overactivation, defined as the transfusion of <2 units of red blood cells, occurred in two cases (12%). Common causes of non-compliance were: 24% (4/17) temperature monitoring, 18% (3/17) lactate measurement, 41% (7/17) arterial blood gas sampling, and 18% (3/17) hemoglobin maintenance within the target range of 55–95 g/L. Admission to intensive care and peripartum hysterectomy occurred in 12 and 5 cases (71% and 29%), respectively.
Suboptimal compliance was found in multiple areas, which may be attributable to the low frequency of activation of our massive haemorrhage protocol in obstetrics. The quality targets identified in this report can act as a basis for other institutions developing quality indicators to evaluate performance.</description><subject>Adult</subject><subject>Blood transfusion</subject><subject>Blood Transfusion - methods</subject><subject>Clinical Protocols</subject><subject>Delivery, Obstetric</subject><subject>Female</subject><subject>Guideline Adherence - statistics & numerical data</subject><subject>Humans</subject><subject>Massive hemorrhage protocol</subject><subject>Massive transfusion protocol</subject><subject>Obstetric Labor Complications - diagnosis</subject><subject>Obstetric Labor Complications - therapy</subject><subject>Postpartum hemorrhage</subject><subject>Postpartum Hemorrhage - diagnosis</subject><subject>Postpartum Hemorrhage - therapy</subject><subject>Pregnancy</subject><subject>Quality Control</subject><subject>Quality improvement</subject><subject>Quality Indicators, Health Care - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Young Adult</subject><issn>0959-289X</issn><issn>1532-3374</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kE9LAzEQxYMotla_gAfJ0cuuyWazTcSLFP9BxYuCnkKanbUpu01N0kq_vVlaPTqXgZk3j3k_hM4pySmh1dUitwun84JQkQY5IeUBGlLOioyxcXmIhkRymRVCvg_QSQgLQohkojpGA0Y4kZUgQ_TxrEOwG8Bz6Jz3c_0JeOVddMa1WJtoNzpat8R2id0sRIjemnCNNebZFrTHX2vd2rjFK_CN851eGsAeNha-T9FRo9sAZ_s-Qm_3d6-Tx2z68vA0uZ1mhvEqZlUjzUwKzvpqoCESZAWCkTHnmhRpZ-qSFaIey7KSZQkzwwRljaRjXtYM2Ahd7nzT219rCFF1NhhoW70Etw6qoGWyL0TKPkLFTmq8C8FDo1bedtpvFSWqR6oWqkeqeqT9LCFNRxd7__Wsg_rv5JdhEtzsBJBSpuReBWMhgaitBxNV7ex__j-AMogN</recordid><startdate>201905</startdate><enddate>201905</enddate><creator>Margarido, C.</creator><creator>Ferns, J.</creator><creator>Chin, V.</creator><creator>Ribeiro, T.</creator><creator>Nascimento, B.</creator><creator>Barrett, J.</creator><creator>Herer, E.</creator><creator>Halpern, S.</creator><creator>Andrews, L.</creator><creator>Ballatyne, G.</creator><creator>Chapmam, M.</creator><creator>Gomes, J.</creator><creator>Callum, J.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7480-5122</orcidid></search><sort><creationdate>201905</creationdate><title>Massive hemorrhage protocol activation in obstetrics: a 5-year quality performance review</title><author>Margarido, C. ; Ferns, J. ; Chin, V. ; Ribeiro, T. ; Nascimento, B. ; Barrett, J. ; Herer, E. ; Halpern, S. ; Andrews, L. ; Ballatyne, G. ; Chapmam, M. ; Gomes, J. ; Callum, J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-6f9cb98533333fef09e96e830755a02cb9cd4328d7946944ebc3813f91754d3e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Blood transfusion</topic><topic>Blood Transfusion - methods</topic><topic>Clinical Protocols</topic><topic>Delivery, Obstetric</topic><topic>Female</topic><topic>Guideline Adherence - statistics & numerical data</topic><topic>Humans</topic><topic>Massive hemorrhage protocol</topic><topic>Massive transfusion protocol</topic><topic>Obstetric Labor Complications - diagnosis</topic><topic>Obstetric Labor Complications - therapy</topic><topic>Postpartum hemorrhage</topic><topic>Postpartum Hemorrhage - diagnosis</topic><topic>Postpartum Hemorrhage - therapy</topic><topic>Pregnancy</topic><topic>Quality Control</topic><topic>Quality improvement</topic><topic>Quality Indicators, Health Care - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Margarido, C.</creatorcontrib><creatorcontrib>Ferns, J.</creatorcontrib><creatorcontrib>Chin, V.</creatorcontrib><creatorcontrib>Ribeiro, T.</creatorcontrib><creatorcontrib>Nascimento, B.</creatorcontrib><creatorcontrib>Barrett, J.</creatorcontrib><creatorcontrib>Herer, E.</creatorcontrib><creatorcontrib>Halpern, S.</creatorcontrib><creatorcontrib>Andrews, L.</creatorcontrib><creatorcontrib>Ballatyne, G.</creatorcontrib><creatorcontrib>Chapmam, M.</creatorcontrib><creatorcontrib>Gomes, J.</creatorcontrib><creatorcontrib>Callum, J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of obstetric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Margarido, C.</au><au>Ferns, J.</au><au>Chin, V.</au><au>Ribeiro, T.</au><au>Nascimento, B.</au><au>Barrett, J.</au><au>Herer, E.</au><au>Halpern, S.</au><au>Andrews, L.</au><au>Ballatyne, G.</au><au>Chapmam, M.</au><au>Gomes, J.</au><au>Callum, J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Massive hemorrhage protocol activation in obstetrics: a 5-year quality performance review</atitle><jtitle>International journal of obstetric anesthesia</jtitle><addtitle>Int J Obstet Anesth</addtitle><date>2019-05</date><risdate>2019</risdate><volume>38</volume><spage>37</spage><epage>45</epage><pages>37-45</pages><issn>0959-289X</issn><eissn>1532-3374</eissn><abstract>•Seventeen massive haemorrhage protocol events among 19 790 deliveries (0.09%).•Areas of improvement were consistent laboratory testing and hypothermia monitoring.•Over-transfusion occurred more often than under-transfusion.•The majority of hemorrhages were due to uterine atony and abnormal placentation.•In many cases there was no documentation of a debrief after protocol termination.
A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team.
A multidisciplinary team set the institutional quality indicators for the massive hemorrhage protocol review. A retrospective review of all obstetrical massive hemorrhage protocol activation events from September 2010 to January 2015 was performed. All protocol events occurred before the creation of the quality indicators. Data were retrieved from patient records.
There were 17 (0.09%) protocol activations for 19 790 deliveries during the study period. All 17 (100%) patients received at least one unit of red blood cells. Overactivation, defined as the transfusion of <2 units of red blood cells, occurred in two cases (12%). Common causes of non-compliance were: 24% (4/17) temperature monitoring, 18% (3/17) lactate measurement, 41% (7/17) arterial blood gas sampling, and 18% (3/17) hemoglobin maintenance within the target range of 55–95 g/L. Admission to intensive care and peripartum hysterectomy occurred in 12 and 5 cases (71% and 29%), respectively.
Suboptimal compliance was found in multiple areas, which may be attributable to the low frequency of activation of our massive haemorrhage protocol in obstetrics. The quality targets identified in this report can act as a basis for other institutions developing quality indicators to evaluate performance.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>30509680</pmid><doi>10.1016/j.ijoa.2018.10.004</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7480-5122</orcidid></addata></record> |
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| ispartof | International journal of obstetric anesthesia, 2019-05, Vol.38, p.37-45 |
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| source | ScienceDirect Freedom Collection 2022-2024 |
| subjects | Adult Blood transfusion Blood Transfusion - methods Clinical Protocols Delivery, Obstetric Female Guideline Adherence - statistics & numerical data Humans Massive hemorrhage protocol Massive transfusion protocol Obstetric Labor Complications - diagnosis Obstetric Labor Complications - therapy Postpartum hemorrhage Postpartum Hemorrhage - diagnosis Postpartum Hemorrhage - therapy Pregnancy Quality Control Quality improvement Quality Indicators, Health Care - statistics & numerical data Retrospective Studies Young Adult |
| title | Massive hemorrhage protocol activation in obstetrics: a 5-year quality performance review |
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