Implementation of Thromboelastography on the Labor and Delivery Floor for Postpartum Hemorrhage

INTRODUCTION: Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Thromboelastography (TEG) is a rapid test that has been shown to improve outcomes in PPH by guiding resuscitation quickly and in a targeted manner. We incorporated TEG into our hemorrhage response protocol (HRP), a robust algorithm focused on facilitating immediate response to PPH, in a pilot study at our high-volume academic medical center. The objective of this quality improvement project was to evaluate the feasibility of incorporating TEG as part of our HRP. METHODS: We identified key HRP stakeholders and appointed team leads including obstetricians, anesthesiologists, nurses, and lab/blood bank staff and developed team-appropriate education including 30-minute teaching sessions, badge reference cards, and workflow posters. We then evaluated the TEG utilization rate over time. RESULTS: Thromboelastography was utilized in 4/9 (44%) PPHs during the first week after implementation, 4/7 (57%) the second week, and 28/28 (100%) during the following 4 weeks. After an HRT was called, the median time to order TEG was 4.0 minutes (interquartile range [IQR] 13), the median time to collect TEG was 8.5 minutes (IQR 11.8), and the median time for TEG to result was 7.0 minutes (IQR 7.7). CONCLUSION: We observed 100% uptake of TEG within 3 weeks of implementation, and rapid workflow completion (<10 minutes per step). The strengths of our implementation approach were its multidisciplinary nature, structuring the workflow into the electronic health record, and appointing team leads to facilitate buy-in. Future studies are needed to assess clinical implications and provider comfort with TEG.