Objective Severe maternal morbidity (SMM) has increased by 45% in the United States and is estimated to affect up to 1.5% of all deliveries. Research has not yet been conducted that demonstrates a benefit to multidisciplinary review of SMM. The aim of our study was to determine if standardized, routine review of the cases of SMM by a multidisciplinary committee results in a reduction of potentially preventable cases of SMM.
Study Design A retrospective cohort study of all women admitted for delivery at Cedars-Sinai Medical Center from March 1, 2012 to September 30, 2016. Our cohort was separated into two groups: a preintervention group composed of women admitted for delivery prior to the implementation of the obstetric Quality and Peer Review Committee (OBQPRC), and a postintervention group where the committee had been well established. Cases of confirmed SMM were presented to a multidisciplinary research committee, and the committee determined whether opportunities for improvement in care existed. The groups were compared with determine if there was a decreased incidence of preventable SMM following the implementation of the OBQPRC standardized review process.
Results There were 30,319 deliveries during the study period; 13,120 deliveries in the preintervention group; and 13,350 deliveries in the postintervention group (2,649 deliveries during the transition period). There was no difference in the rate of SMM between the preintervention (125; 0.95%) and postintervention (129; 0.97%) groups, (p = 0.91). There was a significantly lower rate of opportunity for the improvement in care in the postintervention group (29.5%) compared with the preintervention group (46%; p = 0.005).
Conclusion We demonstrated a significant reduction in the rate of potentially preventable SMM following the implementation of routine review of all SMM suggesting that this process plays an important role in improving maternal care and outcomes.
Key Points
(Anesth Analg. 2018;127:1445–1447)
Subspeciality training in obstetric anesthesiology is associated with improved patient outcomes (27% reduction in risk of maternal death). Therefore, it is no surprise that the 2015 American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) consensus document for improved referral and regionalization of high-risk obstetric services proposed defined levels of high-risk obstetric services with specific requirements. Level II centers require a board-certified anesthesiologist with special training or experience in obstetrics available for consultation, whereas in level III-IV centers, this board-certified anesthesiologist must also be “in charge of obstetric anesthesia services” (level I: birth centers, basic care; II: specialty care; III: subspecialty care; IV: regional perinatal health centers). Considering that the demand for obstetric anesthesia services has increased dramatically in the past few decades, the authors of the present article estimate the workforce demand for fellowship-trained obstetric anesthesiologists (FTOAs).
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