#OA4-AM25-ST-22 - Systematic Obstetric Anemia Prevention Across an Integrated Health Network: Impact of Patient Blood Management Nurse Consultation on Hemoglobin Change

Obstetric (OB) anemia is a global, pervasive healthcare challenge affecting 25-50% of pregnancies, varying by region. Anemia imposes serious short and long-term health risks on both the mother and fetus. Systematic application of anemia diagnosis and management protocols may offload healthcare provider burden to combat obstetric anemia, while raising the quality and consistency of care.

Study

Design/Methods:

In February 2021, Geisinger Obstetrics and Patient Blood Management (PBM) implemented a comprehensive diagnostic and management protocol for all pregnancies. The main evaluative contact includes virtual consultation with specialized PBM nurses. A dashboard for tracking patient outcomes was developed in Tableau to extract and display data abstracted from the electronic medical record. Longitudinal hemoglobin (Hgb) trending and overall protocol adherence are key performance indicators for this initiative.

Results/Findings:

From 1 Feb 2021-18 Nov 2024, among 16765 pregnancies, 12807 (76%) recorded at least one prenatal Hgb less than 12 grams per deciliter (g/dL). Of those, 2501 (29%) had a PBM consult, among whom 96% received iron, including 53% oral iron and 85% intravenous (IV) iron. Among the 8632 (71%) who did not get PBM consults, 68% received iron, including 66% oral iron and 8.1% IV iron. More women in the PBM consult group had a Hgb increase of at least 1 g/dL (73% vs 46%, OR = 1.6), and fewer experienced a Hgb drop of at least 1 g/dL (25% vs 51%, OR = 0.5). Overall protocol compliance was 51%, including 60% compliance with indicated PBM consult placement by primary providers. For protocol-qualified pregnancies with PBM consult, the mean Hgb gain was 0.6 g/dL; without PBM consult the mean Hgb decline was -0.1 g/dL.

Conclusions:

Systematic OB anemia prevention protocol centered around PBM Nurse evaluation and management is a powerful tool. We observed a clinically meaningful improvement of anemia through the course of pregnancy among a large single-system cohort. Opportunities for practice improvement related to protocol compliance were identified.