Table 3 Alignment of Final Model Variables with Maternal Levels of Care Criteria
From: Validation of a measure of hospital maternal level of care for the United States
Maternal Levels of Care Criteria | Operationalization as AHA Variable | All Hospitals |
|---|---|---|
Ability to begin emergency cesarean delivery within a time interval that best incorporates maternal and fetal risks and benefits | ORPA > 0 Operating Rooms AND ADTCHOS = 1 Adult Cardiology Surgery | 2278 (97.7%) |
Limited obstetric ultrasonography with interpretation readily available at all times | ULTSNHOS = 1 Ultrasound services | 2294 (98.4%) |
Support services readily available at all times, including laboratory testing and blood bank | FTLAB > 0 Full time lab technicians | 2143 (91.9%) |
Capable to implement patient safety bundles for common causes of preventable maternal morbidity | No variables available | – |
Ability at all times to initiate massive transfusion protocol | No variables available | – |
Stabilization and the ability to facilitate transport to a higher-level hospital when necessary | No variables available | – |
Ability to initiate and sustain education and quality improvement programs | No variables available | – |
Meets Level I Criteria | 2062 (88.5%) | |
Computed tomography scan, Magnetic resonance imaging, non-obstetric ultrasound imaging, and maternal echocardiography available daily | CTSCNHOS = 1 Computed-tomography (CT) Scanner AND MIRHOS = 1 Magnetic resonance imaging (MRI) AND ACARDHOS = 1 Adult cardiology service (for echocardiography) | 1683 (72.2%) |
Standard obstetric ultrasound imaging with interpretation readily available at all times | No variables available | |
Obstetrician-gynecologist available at all times | No variables available | |
Anesthesiology readily available at all times | PCAHOS = 1 Patient controlled analgesia | 2118 (90.9%) |
Internal or family medicine physicians and general surgeons readily available at all times | HSPTL = 1 Hospitalists provide care | 1911 (82.0%) |
Remove if Trauma level 4 | ||
Meets Level II Criteria | 1237 (53.1%) | |
In-house availability of all blood products | No variables available | |
CT, MRI, Ultrasound, and echocardiography available at all times | FTECIC > 0 Full time cardiology intensivists OR CLSCIC = 1 Closed cardiac intensive care unit | 781 (33.5%) |
Specialized obstetric ultrasound and fetal assessment, including doppler studies, with interpretation readily available at all times | No variables available | |
Basic Interventional Radiology | ICLABHOS = 1 Interventional cardiac catheterization | 1343 (57.6%) |
Appropriate equipment and personnel physically present at all times | No variables available | |
Onsite Medical and Surgical ICUS | MSICBD > 0 Medical-surgical intensive care beds OR MSICHOS = 1 Medical-surgical intensive care service | 2071 (88.9%) |
Documented mechanism to facilitate and accept maternal transfers | No variables available | |
Provide outreach education and patient transfer feedback to level I and level II designated facilities | No variables available | |
Provide perinatal system leadership if acting as a regional center | No variables available | |
Full complement of sub-specialists | NEROHOS = 1 (Neurology Service) AND HEMOHOS = 1 (Hematology Service) AND ONCOLHOS = 1 (Oncology service) | 553 (23.7%) |
Remove if Trauma level 3 or Level 4 | Traumal90 ≠ 3 andTraumal90 ≠ 4 | - 34 |
Meets Level III Criteria | 293 (12.6%) |