OB Alert Yellow/OB Alert Red: Implementing a Rapid Response Team for Obstetrical Hemorrhage in a Community Hospital Setting

Tuesday, 13 July 2010

Barbara C. Schuch, BSN, RNC-OB, EFM-C
Sally M. Krempel, BSN, RNC-OB
Birth Center, MacNeal Hospital, Berwyn, IL

Learning Objective 1: The learner will be able to identify risk factors for OB hemorrhage, estimate blood loss, and recognize the physiological signs and symptoms of hemorrhage/ hypovolemia.

Learning Objective 2: The learner will be able to activate the multidisciplinary response team in place for the obstetrical hemorrhage patient during the antepartum, intrapartum and postpartum periods.

The Illinois Department of Public Health requires all hospitals providing obstetrical care in the State of Illinois to implement an obstetrical hemorrhage (OBH) initiative to include:
  • Benchmark exam to assess OBH knowledge
  • OBH education - didactic lecture, and hands on blood loss estimation skill stations
  • OBH drills and debriefing; Implementation of Rapid Response team specific to OBH

This initiative was undertaken in 3 parts as suggested by the IDPH. The Benchmark exam, the OBH didactic and EBL skill stations were initially offered to all personnel providing obstetrical care including, obstetrical providers, nursing and surgical tech staff on L&D, as well as anesthesia personnel.

A two tiered system for the activation of an OB Hemorrhage alert was created modeled after the MacNeal trauma alert standard already in place. The term "OB Alert Red" will initiate a full hemorrhage team response whereas "OB Alert Yellow” will initiate a partial team response.

OB Alert yellow criteria

  • EBL ≥ 1000cc after vaginal delivery
  • EBL ≥ 1500cc after/ during C-section
  • Hemorrhage NOT abated with massage and medical therapy.
  • Patient with signs/ symptoms of Class II hemorrhage (hypovolemia)
OB Alert red criteria
  • EBL >2000cc (vaginal delivery or c-section)
  • Hemorrhage NOT abated with continuous massage and more than 3 pharmacologic agents        
  • Surgical or radiologic intervention necessary
  • Blood/ products replacement necessary
  • Patient with signs/ symptoms of Class III or IV hemorrhage (hypovolemia)

Fewer personnel are required for an OB Alert yellow, but can be elevated to an OB Alert red status involving more personnel as needed. Telecommunication’s role is to perform a mass page having the multidisciplinary team in place with little wasted time.

Our hospital will use the knowledge presented to us to approach OB hemorrhage with a new preparedness to do our part in decreasing preventable maternal mortality.