Abstract
Objective To determine whether a state-level initiative to reduce obstetric venous thromboembolism
(VTE) risk affected outcomes and process measures.
Methods In 2013, the Safe Motherhood Initiative (SMI) developed a VTE safety bundle to reduce
obstetric VTE risk. A total of 117 of 124 hospitals providing obstetrical services
in New York participated in SMI. Data evaluating thromboembolism events (deep vein
thrombosis and pulmonary embolism) and thromboprophylaxis process measures were collected
from March through November 2015.
Results A total of 107 hospitals, in any individual quarter, reported data on each of the
VTE bundle outcomes and measures. Centers that provided low-risk care (Level 1 centers)
reported the lowest rate of bundle implementation at the end of the study period (55.6%).
Mechanical prophylaxis for a cesarean was common at all centers. Hospitals that adopted
the bundle were more likely to provide routine pharmacologic prophylaxis for women
undergoing cesarean. The risk of VTE did not differ by bundle implementation.
Conclusion While adoption of the SMI VTE bundle occurred at a majority of centers across New
York, uptake was less likely at low-acuity centers. Bundle adoption was associated
with implementation of recommended practices. The rare nature of VTE events underscores
the need for large data samples to determine the best prophylaxis strategies.
Keywords
obstetric thromboembolism - thromboembolism prophylaxis - maternal mortality - Safe
Motherhood Initiative
