care and 553 in tertiary care. Place of birth was missing for 74 (8%)neonates, leaving 797 for analysis. Mortality rate differed significantly(Ia 15%, Ib 12%, II 22%, III 1%, p��0.01), as did the diagnosis atadmission, the received treatment, and the median duration of admis-sion in hours (Ia 60.0(21.5-139.0), Ib 59.0(26.5-130.0), II 106.0(49.8-184.0), III 23.0(12.0-51.0, p��0.01).CONCLUSION: The severity of illness of neonates admitted at the NICUdiffered depending on the line of care in which they were born, withneonates born in secondary care consistently having the highest mor-bidity, and those born in tertiary care having the lowest. NICU admis-sion should not be used as an outcome measure for neonatal morbid-ity, certainly not when comparing interventions in different birthsettings.

777 Routine heparin thromboprophylaxis isnecessary for cesarean delivery patientsSarah Anderson1, Jonathan Reiss1, Stephanie Lin1,Daniel Skupski2, Amos Grunebaum1

1New York Weill Cornell Medical Center, Obstetrics and Gynecology, NewYork, NY, 2New York Hospital Queens, Obstetrics and Gynecology, NewYork, NYOBJECTIVE: To assess our obstetric population’s risk factors for venousthromboembolism (VTE) and determine adherence to current RoyalCollege of Obstetrics and Gynecology (RCOG) guidelines for peripar-tum thromboprophylaxis with low molecular weight heparin(LMWH).STUDY DESIGN: Retrospective review of 500 consecutive births from11/2010 to 12/2010. Patients with risk factors indicating a need foradditional VTE prophylaxis with LMWH were compared with thosepatients who received LMWH using current RCOG criteria.RESULTS: Thromboprophylaxis with LMWH was indicated in 266/500 (53.2%) of all of our patients, 143/159 (89.9%) of patients under-going cesarean delivery (CD), and in 123/341 (36.1%) of patientshaving vaginal birth (VB). Of the women at risk for VTE, the percent-age of those who received thromboprophylaxis with LMWH in thesethree groups was only 16/266 (6.0%), 9/143 (6.3%), and 7/123 (5.7%)respectively. Top risk factors for VTE were: age over 35, BMI � 30,elective or indicated CD, and preeclampsia (Table).CONCLUSION: Over one-half of all deliveries (53.2%), and a majority ofcesarean delivery patients (89.9%) in our population had an indica-tion for LMWH thromboprophylaxis. Only a minority of patients(6.0% of all patients, 6.3% of CD patients and 5.7% of VB patients)actually received LMWH. A checklist-based system may provide ap-propriate thromboprophylaxis for many patients who are currently atrisk for VTE without intervention. Given that the vast majority of ourCD patients are at risk of VTE, administering universal postoperativeLMWH thromboprophylaxis to all patients undergoing CD without acontraindication to LMWH would prevent missing any CD patientswho are at risk.

778 Quality of labor & delivery sign-out varieswith time of day and provider typeSarah Goff1, Daniel Grow2, Alexander Knee2, Fadi Bsat2

1Baystate Medical Center, Medicine, Springfield, MA, 2Baystate MedicalCenter, Obstetrics & Gynecology, Springfield, MAOBJECTIVE: Patient care in labor & delivery is intuitively sensitive tothe quality of provider sign-out because it spans across different shiftsand providers. We sought to determine whether the quality of sign-outs differs between AM versus PM, weekend versus weekday, or withprovider type.STUDY DESIGN: With institutional review board approval, we devel-oped an observational tool to assess whether the 8 elements of aneffective sign-out were present, as described by the American Con-gress of Obstetricians and Gynecologists (ACOG). We prospectivelyobserved patient sign-outs in labor & delivery between attendings,residents, nurses and certified nurse midwives. Observation times in-cluded a balance of mornings, evenings, weekdays and weekends. Par-ticipants were blinded to the study objectives. We defined as highquality sign-outs those that included 7 of the 8 recommended ACOGelements. Analysis was at the individual patient level, using Fisher’sexact test for statistical analysis where needed.RESULTS: A total of 422 patient sign-outs were observed; 233 (55%)took place in the AM, 189 (45%) in the PM; 251 (59%) were onweekdays, 171 (41%) on weekends. A total of 201 (48%) were pre-sented by obstetrical residents, 139 (33%) by labor & delivery nurses,56 (13%) by attending obstetricians, and 26 (6%) by certified nursemidwives. Only 169 (40%) of all sign-outs were classified as high qual-ity. A greater percentage of AM sign-outs were high quality comparedto PM (45% versus 34%, p�0.04). There was no difference betweenoverall weekday and weekend sign-outs (39% versus 42% p�0.48).Residents had the most high quality sign-outs (55%) compared toattendings (7%) and nurses (32%), p�0.001. The element most com-monly distracting from high quality sign-out was the use of technicallanguage (n�316, 75%).CONCLUSION: Based on criteria used in this study, sign-out quality var-ied with time of day and provider type. These findings present anopportunity to further assess reasons for this variation and proposechanges to improve the sign-out process.

779 To compare cost effectiveness for routine type andscreen for patients undergoing cesarean sectionand vaginal deliveryNauman Khurshid1, Shannon Connole1

1University of Toledo Medical Center, Obstetrics and Gynecology, Toledo,OHOBJECTIVE: To evaluate the cost of universal type and screen in allpatients admitted for delivery at The Toledo Hospital.STUDY DESIGN: This is a retrospective chart review of all patients thatreceived blood transfusion that delivered at The Toledo Hospital from2004 to 2009.RESULTS: Of 27,000 patients that delivered at The Toledo Hospitalfrom 2004 to 2009 ,51 pregnant patients received blood transfusion(0.05%). The average cost of type and screen is $250. The averageamount of blood transfusion was 1 PRBC. On average each transfu-sion costs $250. Most of the transfusions were related to previouslyidentified risk (anemia, placenta previa , cesarean hysterectomy, post-partum hemorrhage). A decision analysis model based on 2 decisiontrees was constructed (Figure). One tree was designated as type andscreen (T&S) and the other no type and screen arm (no T&S). Analysiswas done based on rate of transfusion, survival after transfusion, rateof mortality and morbidity nationally and compared with our data.The cost of the T&S and no T&S tree was then analyzed. We demon-strate that annual cost of Toledo Hospital for universal T&S is approx-imately $1,127,610 per year. However, if T&S is done only on patientswith identifiable risk, the annual cost drops to $2,610.

Risk factors for VTE in pregnancy

Poster Session V Clinical Ob, Epidemiology, ID, Intrapartum Fetal, Operative Ob, Med-Surg-Diseases, Ob Quality & Safety, Public & Global Health www.AJOG.org

S326 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2013