Preparing for Ob/Gyn Emergencies: ACOG Issues Tips

Steven Fox

February 20, 2014

Preparation is essential in clinical emergencies, and now the American College of Obstetrics and Gynecologists has provided advice on just how to prepare for such situations in obstetrics and gynecology practices and departments.

Obstetrics/gynecology emergencies are especially common among hospitalized patients, but they can occur in any setting, the authors note in a committee opinion published online February 19 and in the March issue of Obstetrics and Gynecology.

They also stress that the incidence of certain types of emergencies are on the rise. For example, during the last decade, the incidence of severe maternal morbidity in the United States has increased by 75% for complications associated with delivery. One such complication, postpartum hemorrhage, has increased even more, going up by as much as 114% according to some estimates.

"It is important that obstetrician–gynecologists prepare themselves by assessing potential emergencies, establishing early warning systems, designating specialized first responders, conducting emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement," they write.

The authors provide several examples of specific tools clinicians can use to help them deal with obstetric/gynecological emergencies.

For instance, they advise maintaining appropriate emergency supplies on a "crash" cart or kit, thereby avoiding the need to hunt for such supplies when emergency situations arise.

They also emphasize the importance of designating and training a rapid response team, as well as regularly scheduling drills and simulations so that each member of the team knows what to do.

Lack of teamwork, coupled with subpar communication, has been implicated as the leading cause of perinatal and maternal death in emergency situations. Optimal communication between rapid response team members is particularly important, the authors point out. They advise training all staff in the use of a formal standardized communication tool, such as the Situation-Background-Assessment-Recommendation tool (SBAR).

The authors also emphasize that many emergencies can be avoided if physicians, nurses, and other bedside caregivers watch for changes in patients' clinical status that may signal the need for intervention. Examples are sudden onset of agitation or difficulty with movement. "These triggers mandate further actions by the health care team according to protocol, such as bringing the attending physician to the patient's bedside immediately," they write.

They emphasize that recognition of those sorts of "triggers" can be incorporated into protocols. One such protocol is the Modified Early Obstetric Warning System, developed in the United Kingdom.

The authors concede that the precise nature of such protocols will need to vary to fit specific work environments and the availability of resources.

However, they conclude, "Prompt recognition of and response to critical clinical scenarios, teamwork, and training enhance patient safety and mitigate the severity of adverse outcomes."

The authors have disclosed no relevant financial relationships.

"Preparing for Clinical Emergencies in Obstetrics and Gynecology." American College of Obstetricians and Gynecologists Committee on Patient Safety and Quality Improvement. Full text

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