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Q&A

Obstetric Quality and Safety

Poster Session 3

(658) Impact of an SMME Committee on All Cause and Preventable Maternal Morbidity

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

An excess burden of maternal morbidity is experienced by pregnant people in the American south compared to other regions of the US.  Implementation of a high fidelity, multidisciplinary severe maternal morbidity event (SMME) review committee may be associated with reductions in preventable events over time. Our objective was to measure temporal changes in SMME at the state’s largest delivery hospital after SMME committee implementation.  We hypothesized that preventable SMME rates would decrease over time.

Study Design:

A cross-sectional study of cases reviewed at SMME committee from 2019-2022, including pregnant or postpartum people who received ≥4 units of PRBCs, had unplanned ICU admission, were diagnosed with eclampsia, were diagnosed with an infection with opportunity for improvement, underwent an unplanned hysterectomy, or were referred for review.  We compared the rates of patients receiving ≥ 4 units of PRBCs, ICU utilization, and maternal mortality across years using Mann Kendall Trend Tests.chi squared trend tests.

Results:

316 cases of SMME out of 16,501 total deliveries are included in this analysis (SMME rate, 1.9%).  There was a significant reduction in the rate of SMME from 2019-2022 (p=0.04). The most common causes of SMME were postpartum hemorrhage (30.0%); “other events” including DKA, renal failure, solid organ arterial aneurysm rupture, and respiratory failure (21.8%); and pre-eclampsia/eclampsia (12.7%).  The rate of ICU utilization significantly decreased over time (p=0.02), but blood product utilization did not.  Forty-one percent of cases were considered preventable (n=130) and opportunity for improvement was identified largely at the provider level (30.8%, n=40) and combination provider-system level (13.8%, n=18).  The rate of preventability did not change over the 4 years. 

Conclusion:

The implementation of an SMME review committee was associated with significant reductions in absolute SMME rate and ICU utilization over time.