Obstetric Emergency Preparedness in Arkansas Emergency Departments: Results From a Cross-Sectional Survey.

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 calculated. 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 report a birth (27% versus 56%), to have the capacity to perform some obstetric procedures such as administering uterotonic drugs (58% versus 100%), and to require assessment of postpartum status in the electronic health record (0% versus 33%). The majority (16/35; 46%) of responding ED managers had not offered obstetric emergency training to staff in the last 2 years. Conclusion: Although 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.