An Effort To Reduce Maternal Mortality at Stony Brook Medical Center
By Rachel Young A woman is rushed to the operating room after giving birth. The baby is fine, but the mother is hemorrhaging, losing blood at a rate of about one cup per minute. In eight minutes, she could lose her total blood volume. Hospital staff pages a response team whose responsibility it is to stop the bleeding -- and fast. Stepping into a 24-hour emergency service elevator, they are rushed to the patient, bags of blood in hand. In 2004, the New York State Department of Health strongly recommended that hospitals implement a system to reduce the state’s high rate of maternal mortality – the death of a woman during or shortly after pregnancy. Perinatal Service at the Medical Center developed a protocol called Code Noelle in 2004 to reduce hemorrhaging during and after a woman gives birth - the most preventable cause of maternal death. Perinatal refers to the period immediately before and directly after giving birth. A response team was created to improve the processes connected with taking care of women at high risk of hemorrhage during and after childbirth. The Maternal Hemorrhage Task Force, made up of Obstetric and Gynecology physicians, anesthesiologists, nurses and residents, works with the blood bank and distribution services, like elevators, and focuses on rapid delivery of blood products to hemorrhaging women. It has an average response time of one to two minutes, Adriann Combs, a registered nurse and regional perinatal center coordinator of Code Noelle, said. “This hospital is committed to making sure maternal outcomes are optimized,” Combs said. She said the Medical Center has given Code Noelle demonstrations to other state hospitals, and that North Shore Hospital also has a process for handling maternal hemorrhage. “[The code] has helped us recognize women at high risk for hemorrhage and decrease [deaths] from it,” she said. According to a document authored by Combs and seven other task members working in specialized fields, New York State has the highest rate of maternal mortality in the U.S. at 12.9 deaths per 100,000 live births. In Feb. 2007, the Center for Disease Control said the U.S. maternal mortality death rate in 2003 was 12.1 deaths per 100,000 live births. In 1915, according to the CDC, that rate was nearly 608 deaths per 100,000 live births. According to an Aug. article from cbsnews.com, "U.S. women are dying from childbirth at the highest rate in decades." The article cites maternal obesity and an increase in Caesarean sections as possible factors. “Ninety-seven percent of all maternal hemorrhages occur in hospitals,” Combs said. Patients at risk include women who have had multiple caesarean sections, placenta previa – when the uterus blocks the cervix, and women carrying more than one baby. Said Paul Ogburn Jr., director of maternal and fetal medicine, in reference to the task force members, "Having the code has given us a bigger set of arms." Conducting drills quarterly is a way of identifying problems with the processes. Ogburn said they help prevent an actual Code Noelle. “Heavy bleeding doesn’t necessarily mean you have a Code Noelle if you plan ahead of time,” he said. “We call the code less now than we did in the past.“ This doesn’t mean the need for it will diminish. Ogburn said he was unable to give statistics for how many times Code Noelle has been performed over the past three years. Combs said that when a Code Noelle is called, members are contacted through a group paging system and an overhead speaker. A $20,000 computerized mannequin called Noelle, for whom the code gets its name, is used for drills and was purchased by a grant written by Todd Griffin, Assistant Director of the OB-GYN Residency Program. Noelle can simulate giving birth and “was modified to be used in hemorrhage simulation,” according to the Code Noelle document. “She can be used to test clinical knowledge of the response team," Combs said. An emergency service elevator is manned twenty-four hours a day for critical personnel use and to deliver appropriately labeled blood products from the blood bank. “Drills are an educational and a feedback piece,” Rishimani N. Adsumelli, an anesthesiologist on the response team, said. Ogburn said the drills take people from different backgrounds and get them working together towards the same goal. “The key is to have the access to stop [a hemorrhage], even if you don’t know where it’s coming from,” he said. |
