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Standardized severe maternal morbidity review: rationale and process.

Sarah J Kilpatrick1, Cynthia Berg, Peter Bernstein

  • 1Departments of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, Montefiore Medical Center, Bronx, New York, University of Florida College of Medicine, Gainesville, Florida, Virginia Commonwealth University, Richmond, Virginia, California Pacific Hospital, San Francisco, California, Medical College of Wisconsin, Milwaukee, Wisconsin, and Wake Forest University, Winston-Salem, North Carolina; the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; the Association of Women's Health, Obstetric and Neonatal Nurses and the American College of Obstetricians and Gynecologists, Washington, DC; the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California; the University of Colorado College of Nursing, Aurora, Colorado; and the Cooper University Hospital, Cooper Medical School, Rowan University, Camden, New Jersey.

Obstetrics and Gynecology
|July 9, 2014
PubMed
Summary

Rising severe maternal morbidity and mortality necessitate a standardized review process. This expert opinion provides guidelines for interdisciplinary reviews to improve obstetric safety and reduce maternal deaths.

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Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Healthcare Quality Improvement

Background:

  • Severe maternal morbidity and mortality rates are increasing in the United States.
  • A national call exists to identify and review severe maternal morbidity cases.
  • No standardized guidance for reviewing these critical cases has been provided.

Purpose of the Study:

  • To present guidelines for a standardized, interdisciplinary severe maternal morbidity review process.
  • To identify systems, professional, and facility factors contributing to severe maternal morbidity.
  • To improve institutional obstetric safety and reduce severe maternal morbidity and mortality.

Main Methods:

  • Development of guidelines by a multidisciplinary working group including obstetrician-gynecologists, maternal-fetal medicine specialists, nurse-midwives, and registered nurses.
  • Presentation of a standardized review process covering committee organization, medical record abstraction, review culture, data management, timing, and confidentiality.
  • Reference to a sample severe maternal morbidity abstraction and assessment form.

Main Results:

  • A comprehensive process for standardized severe maternal morbidity review is presented.
  • Guidelines address key components of the review process, from organization to confidentiality.
  • The proposed process aims to facilitate the identification of actionable improvement areas.

Conclusions:

  • Standardized interdisciplinary review is crucial for addressing severe maternal morbidity.
  • Implementing these guidelines can enhance obstetric safety and reduce maternal morbidity and mortality.
  • A systematic approach is essential for effective quality improvement in obstetric care.