Evaluating the implementation of maternal safety bundles for obstetric hemorrhage and severe hypertension during pregnancy in Arkansas.

BACKGROUND

Maternal mortality remains a critical public health concern in the U.S., with rising rates in recent years. Obstetric hemorrhage and hypertension in pregnancy are leading causes of preventable maternal mortality and morbidity. Maternal safety bundles, developed by the Alliance for Innovation on Maternal Health, provide guidelines to improve maternal health outcomes. This study examined the implementation of obstetric hemorrhage and severe hypertension safety bundles in Arkansas hospitals, identifying factors associated with successful adoption.

METHODS

Safety bundle implementation data were collected from 37 hospitals in the third quarter of 2023. Hospital characteristics were obtained from the American Hospital Association database. Implementation index scores were calculated as the percentage of recommended elements adopted, both overall and within specific domains. Descriptive statistics summarized hospital characteristics and implementation status. Implementation differences across domains were assessed using Friedman's test and Wilcoxon signed-rank test, while between-bundle comparisons were evaluated using the Wilcoxon-Mann-Whitney test.

RESULTS

A total of 23 hospitals (62%) were in the urban region, while 14 hospitals (38%) were located in rural areas. In the obstetrical hemorrhage bundle, Readiness domain had significantly higher implementation than Recognition and Prevention (p = 0.0005) and Reporting and Systems Learning domains (p < 0.0001). In the severe hypertension bundle, Readiness (p < 0.0001), Recognition and Prevention (p = 0.0035), and Response (p < 0.0001) domains all had higher scores than Reporting and Systems Learning domain. The Recognition and Prevention domain had significantly higher implementation in the severe hypertension bundle than in the obstetrical hemorrhage bundle (p = 0.0351). Urban hospitals had significantly higher obstetrical hemorrhage bundle implementation scores than rural hospitals (p = 0.0121). Hospitals with more full-time facility personnel and registered nurses demonstrated better implementation of both obstetrical hemorrhage (facility personnel: p = 0.0454; registered nurses: p = 0.0126) and severe hypertension (facility personnel: p = 0.0180; registered nurses: p = 0.0093) bundles.

CONCLUSIONS

Readiness components were the most frequently implemented, while Reporting and Systems Learning elements had lower adoption rates. Urban hospitals had higher obstetric hemorrhage bundle implementation levels than rural hospitals. Hospitals with greater staffing resources, particularly full-time facility personnel and registered nurses, demonstrated better implementation of safety bundles. Findings highlight the need for targeted interventions to enhance maternal safety bundle adoption, especially in rural hospitals and under-implemented domains.