Despite growing evidence that expert advice on how to track blood loss, not visual estimates, and the timely delivery of antihypertensive medicines can prevent deaths among pregnant mothers, a USA Today study has found that many hospitals practice it completely omit, endangering the lives of patients.
The investigation said that blood loss during childbirth can not be tracked and that blood pressure medication can not be delivered within one hour of dangerously high blood pressure levels, leading to strokes, massive bleeding and even organ failure, blood clots, infections and inability to carry more children. In fact, every year 50,000 women are severely injured as a result of birth-related incidents and 700 mothers die, USA Today said, and at least half of them are preventable with better treatment.
The study included more than half a million pages of internal hospital quality records, the examination of 1
For example, in New York, Pennsylvania and North / South Carolina hospitals, less than half of the maternity hospital patients timely treatment for hypertension, which puts them at risk for stroke. Some of the hospitals reported a rate of less than 15 percent of vulnerable mothers receiving appropriate treatment. Hospitals also admitted in interviews that they did not take the necessary steps to quantify a mother's blood loss or to find out if mothers with acute blood pressure were receiving medication within the recommended one-hour timeframe. These problems have been noted in both large and small hospitals.
While other developed countries have seen a widespread introduction of safety measures and corresponding decreases in maternal mortality, maternal mortality in the US has risen from 15 to 20 deaths per 100,000 births in 1990 to 26.4 in 2015. The states with the worst death rates for the mother were listed as Louisiana, Georgia, Indiana, Texas, and New Jersey, according to the report.
In one case, a new mother was sent home with her newborn despite high blood pressure. She returned hours later with even higher blood pressure and severe headaches in the hospital emergency room. She had to spend hours in the emergency room, where she suffered a stroke and later died.
The investigation also revealed that the lack of guidance on best practices and preventive measures was not the issue. In California in 2010, which reported a markedly lower maternal mortality rate compared to the national average and a more consistent approach to prevention and best practices, researchers began to promote "toolkits" consisting of policies, procedures and checklists that threaten and save lives from mothers. They were made available to hospitals nationwide and contained information such as blood pressure levels of 85/45 or less, which signaled that a woman was losing life-threatening blood, and women who delivered by caesarean section could have internal bleeding that was not visible.
In 2011, the American College of Obstetricians and Gynecologists looked at the risk of high blood pressure in the birth of mothers as one of the leading obstetricians. A 2011 bulletin to vendors gave detailed instructions to hospitals and physicians on how to identify and treat this medical threat and which medications to administer.
In 2014, a collaborative team of leading medical societies formed the Alliance for Innovation in Maternal Health Innovation and formalized practices that reduced maternal injury and death to "safety packages" that expressed treatment policies, safety equipment and training programs, and internal reviews every maternity hospital should have. The bundles were sponsored by well-known groups such as ACOG and the American Academy of Family Physicians.
The recommendations set deadlines for blood pressure measurement and administration of medication to pregnant women and young mothers with dangerously high blood pressure.
USA Today received internal hospital data from dozens of hospitals as part of other voluntary quality improvement programs in 2015 and 2016. Among other things, some of the federally funded programs have determined how many times employees have given recommended blood pressure medications within the one-hour prescribed time limit.
Despite the myriad of information, warnings, and training, care continued to be delayed, and the study found that among the approximately 40 maternity wards in New York State, fewer than half of the mothers were treated with dangerously high blood pressure, records show; Data for approximately a dozen Pennsylvania hospitals showed the mothers who were treated immediately only 49-67 percent of the time.
Greensboro Women's Hospital, North Carolina, delivers more than 6,000 babies per year and offers "world-class service" on its website, but according to its data from October 2015 to June 2016, there were 189 no timely blood pressure treatments from 219 mothers , The mistakes occurred even though employees knew their performance was being monitored, USA Today said.
Cone Health, which operates the Women's Hospital, said its performance during this period was due to the fact that they had just started training staff to treat dangerously high blood pressure and that the ACOG treatment guidelines were not prescribed. Doctors needed time to analyze and evaluate the recommendations of experts. Now, as they participate in a nationwide quality program and apply recommended guidelines, from June 2016 to April 2017, 84 percent of mothers received adequate blood pressure treatment and the number of birth mothers who had seizures and strokes decreased. Similar positive results were observed in other hospitals adopting the best practices of Californian researchers and AIM, the study said.
But transparency and lack of uniform requirements for all hospitals are a problem. US maternity hospitals are not required to follow best practices. And the investigation showed that even if you ask the right questions, there is no guarantee that you will receive answers regarding the safety data of a hospital or if you follow the best safety precautions.
Out of 75 hospitals in 13 states repeatedly contacted by USA Today to ask for details on whether they are following the recommended practices of the AIM program for haemorrhage and hypertension, half refused to respond. And those who did that did not paint an encouraging picture.
"The 37 birthing clinics that responded to USA Today's questions said they made many of the best practices in the AIM program to prevent women from bleeding to death, but more than 40 percent admitted that they did Do not quantify blood loss after each birth To ensure that women with dangerous blood pressure levels received appropriate treatment within 60 minutes, hospital responses also reported lax compliance: out of 31 hospitals that followed a 60-minute treatment policy, Only nine people said they were tracking how often doctors and nurses were treated on time, "the report said.
The call for more transparency in the healthcare industry has grown louder, both in terms of quality and cost, driven by the overall consumer trend. Patients are becoming a driving force in the payer mix, taking on greater financial responsibility and demanding more from their caregivers and providers. Often, however, they have difficulty in obtaining accurate estimates of the care they should undergo, or sometimes information about what a particular service might cost.
For the same reason, quality rankings indicating the safety or lack of hospital services are becoming increasingly important. Consumers want the best option and they are willing to do the research and even travel on to find it. Hospitals that are slow or reluctant to find modern or even common sense, best practices that are demanded by informed consumers, with slipping patient volumes if they are not in compliance with prescribed safety guidelines or if there have been major safety issues in the past. Today's consumers are fluent online and connected to their peers. Both are sources of information that can serve a hospital well or poorly, depending on their own performance. A hospital that can show it follows the latest or most widely-announced security practices and can secure it with stellar or even greatly improved performance data, which has the advantage of attracting and retaining loyal patients, not to mention saving lives.
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