Hospitals are lacking in safety practice adoption that saves lives of birthing mothers, investigation finds

Despite mounting evidence that expert recommendations such as tracking blood loss, not relying on visual estimates and timely administering of medication for high blood pressure can prevent death among birthing mothers, a USA Today investigation has found that many hospitals skip the practices altogether, endangering patients' lives.

The investigation said failing to track blood loss during childbirth and not administering blood pressure medication within an hour of dangerously high blood pressure readings can lead to strokes, massive hemorrhaging to the point of organ failure, blood clots, infections and the inability to bear more children. In fact, each 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 these are preventable with better care.

The investigation included more than a half-million pages of internal hospital quality records, examination of 150 cases in which the childbirth went very wrong as well as the polling of 75 birthing hospitals to see whether they followed recommended procedures. All of these revealed a "stunning lack of attention to safety recommendations and widespread failure to protect new mothers," USA Today said.

For example, in New York, Pennsylvania and North/South Carolina hospitals, less than half of maternity patients received timely treatment for high blood pressure that put them at risk for stroke. Some of the hospitals showed a less than 15 percent rate of mothers in danger who got proper treatment. Hospitals also admitted in interviews that they were not taking the needed steps to quantify a mother's blood loss or tracking whether moms with spiking blood pressure got medication within the recommended time frame of an hour. These issues were found at both large and small hospitals.

While other developed countries have seen widespread adoption of safety measures and corresponding drops in maternal deaths, the maternal death rate in the U.S has risen from  between 15 and 20 deaths per 100,000 births in 1990 to 26.4 in 2015. The states with the worst rates for maternal death 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 readings. She returned to the hospital's ER hours later with even higher blood pressure and a severe headache. She was left to languish in the ER waiting room for hours, where she suffered a stroke and later died.

The investigation also found that lack of guidance on best practices and preventative measures wasn't the issue. In 2010 in California, which the report said boasts significantly lower rates of maternal death compared to the national average and a more unified approach to prevention and best practices, researchers started promoting "toolkits" made up of policies, procedures and checklists designed to pinpoint medical threats and save mothers' lives. They were made available to hospitals nationwide and contained information such as blood pressures of 85/45 or below signaled that a woman was losing life-threatening amounts of blood and women who delivered by C-section could have internal bleeding that is hidden from sight. 

In 2011, the American College of Obstetricians and Gynecologists addressed the dangers of high blood pressures in birthing mothers as one of the leading childbirth killers. A 2011 bulletin to providers gave detailed instructions  for hospitals and doctors on how to identify and deal with this medical threat, even spelling out what medications to administer.

In 2014, a collaborative team of leading medical societies formed the Alliance for Innovation on Maternal Health Program and formalized practices that have proven to reduce maternal injuries and death into "safety bundles," spelling out treatment policies, safety equipment, training programs and internal reviews that every maternity hospital should have. The bundles were sponsored by well-known groups like ACOG and the American Academy of Family Physicians.

The recommendations set time deadlines for taking blood pressure readings and getting medications to pregnant women and new moms experiencing dangerously high blood pressure.

USA Today obtained internal hospital data collected from dozens of hospitals in 2015 and 2016 as part of other voluntary quality-improvement programs. Among other things, some of the federally funded programs tracked how often staff gave recommended blood pressure medicine within the stipulated one-hour deadline. 

Despite the myriad of information, warning and training available, care continued to lag, the investigation showed including the following examples: among roughly 40 maternity hospitals in New York state, less than half of mothers experiencing dangerously high blood pressure got proper treatment, the records show; data for about a dozen Pennsylvania hospitals showed mothers being promptly treated only 49 to 67 percent of the time.

Women's Hospital in Greensboro, NC delivers more than 6,000 babies a year and touts "world-class service" on its website, yet according to their data from October 2015 through June 2016, it failed to give timely blood pressure treatment to 189 out of 219 mothers. The mistakes occurred despite staff awareness that their performance was being monitored, USA Today said.

Cone Health, which operates Women's Hospital, explained their performance in that time frame was due to the fact that they had just started staff training on treating dangerously high blood pressure, and because the ACOG treatment guidelines weren't mandatory, their own physicians needed time to analyze and evaluate the recommendations issued by experts. Now that they are participating in a federal quality program and incorporating recommended guidelines, from June 2016 to April 2017, 84 percent of mothers got proper blood pressure treatment and the number of birthing mothers who suffered seizures and strokes dropped. Similar positive results were seen in other hospitals which adopted the best practices laid out by California researchers and AIM, the investigation said.

But transparency and a lack of unified requirements for all hospitals is a problem. U.S. maternity hospitals are not required to follow best practices. And the investigation found that even if you ask the right questions, there is no guarantee you'll get answers regarding a hospital's safety record or if they follow best safety practices.

Out of 75 hospitals in 13 states repeatedly contacted by USA Today looking for specifics on whether they follow the AIM Program's recommended practices for hemorrhage and hypertension, half refused to respond. And those who did, did not paint an encouraging picture.

"The 37 maternity hospitals that answered USA Today's questions said they are doing many of the AIM program's best practices to prevent women from bleeding to death. But more than 40 percent acknowledged they were not quantifying blood loss after every birth – despite it being a cornerstone safety practice. When it came to ensuring women with dangerous blood pressure readings got proper treatment within 60 minutes, the hospitals' answers also indicated lax compliance. Of 31 hospitals that said they follow a 60-minute treatment policy, only nine said they track how often doctors and nurses actually gave treatment in time," the report said.

There is a rising chorus of calls for greater transparency across the healthcare industry, both from a quality and cost standpoint, fueled by the sweeping trend of consumerism. Patients are becoming a force within the payer mix, taking on more financial responsibility and demanding more from their care and providers. Yet, they often struggle to get accurate estimates for the care they are slated to undergo, or sometimes any information on what a particular service might cost. 

Quality rankings that showcase the safety or lack thereof of hospital performance are gaining traction for the same same reason. Consumers want the best option and they are willing to do the research and even travel farther to find it. Hospitals that are slow or reluctant to adopt cutting edge, or even common sense, best practices demanded by informed consumers may find themselves with slipping patient volume if they are not in line with prescribed safety guidelines or if there have been major safety issues in their past. Today's consumer is much more fluent in online research and connected to their peers, both of which 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 heralded, safety practices and can back it up with stellar or even greatly improved performance record will have the advantage in gaining and keeping loyal patients, not to mention saving lives.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com