The telehealth MOM study: Protocol for a randomized controlled trial of the telehealth multi-component optimal model (MOM) of postpartum care.

Abstract

Objectives: This cross-sectional study of hospital emergency departments (EDs) in Arkansas sought to: 1) assess ED experiences and capabilities related to obstetric emergencies, and; 2) characterize the differences in ED practices for pregnant and postpartum patients between hospitals with and without obstetric services.

Methods: Online survey invitations were distributed to department managers at hospital EDs across Arkansas in August 2023. The 40-question survey collected hospital characteristics, ED experiences with and capacity to manage obstetric emergencies, and staff training history and interest. Responses were descriptively analyzed, and differences in proportions between hospitals with and without obstetric services were tested.

Results: Managers for 51 (61 %) of the 84 eligible EDs responded. Seventy-one percent of EDs (35/49) had an urgent transport of a pregnant or postpartum patient, and 43 % (20/47) had a birth in the prior 12 months. EDs in hospitals without obstetric services were less likely to have a birth (27 % v. 56 %), to have capacity to perform some obstetric procedures such as administering uterotonic drugs (58 % v. 100 %), and to require assessment of postpartum status in the electronic health record (0 % v. 33 %). The majority (19/35; 54 %) of responding ED managers had not offered obstetric emergency training to staff in the last two years.

Conclusions: While obstetric emergencies are not uncommon in the Arkansas hospital EDs represented in this study, many EDs have gaps in their preparedness to identify and manage these cases. Key opportunities for improving preparedness in this sample include training staff and requiring assessment of both pregnancy and postpartum status for women of reproductive age.

Bottom line: There is limited data on Emergency Department (ED) practices related to obstetric complications. We conducted a cross-sectional survey with managers of 51 (61 %) hospital-based EDs in Arkansas to assess EDs' experiences with, and capability to manage, obstetric emergencies. During the prior year, a precipitous birth occurred at roughly 1 in 3 EDs, and an urgent transport of a pregnant or postpartum patient occurred at 2 in 3 EDs. Key opportunities to improve ED practices include implementing consistent assessment of postpartum status and providing staff training on obstetric topics.