Toolkit for treating obstetric hemorrhage saves lives, lowers health care costs

Measures used at California hospitals to stop excessive bleeding in childbirth are saving an average of almost $18 per birth, for statewide annual health care savings of $9 million, according to new research by scientists at Stanford Medicine and the California Maternal Quality Care Collaborative.

Most of the savings come from preventing emergency hysterectomies because hemorrhages during childbirth can be quickly stopped, the study found.

The research, published this month in Obstetrics and Gynecology, examined the financial impact of equipping hospitals with a toolkit composed of evidence-based measures for treating severe bleeding during birth, also known as obstetric hemorrhage. The toolkit, introduced in 2010, is now used at nearly all California hospitals where babies are born. The research team looked at the bottom-line balance of expenditures and savings from implementing the toolkit, as well as its cost-effectiveness, which accounts for the financial value of its effect on patients' well-being.

Using the toolkit saved hospitals money and was cost effective, the researchers found.

"Quality improvement efforts in maternity care not only save lives; they can save costs," said study co-author Elliott Main, MD, clinical professor of obstetrics and gynecology at Stanford Medicine and medical director of the California Maternal Quality Care Collaborative.

The study's lead author is Erik Wiesehan, graduate student in health policy. Its senior author is Jeremy Goldhaber-Fiebert, PhD, professor of health policy.

The savings applied in both large and small hospitals, and the toolkit was more cost-effective in smaller hospitals, the research team found.

We can now say to hospital administrators, 'Not only is this the right thing to do because you can save lives, but it will in fact save you money,'"

Elliott Main, MD, clinical professor of obstetrics and gynecology at Stanford Medicine

Better, more equitable hemorrhage treatment

Obstetric hemorrhage is one of the top complications of childbirth, as well as a major cause of other medical problems, such as emergency hysterectomy and maternal death, worldwide. The collaborative, composed of experts from around the state who research ways to improve pregnancy and childbirth care, developed its obstetric hemorrhage toolkit to provide hospitals with a detailed set of evidence-based medical practices for treating these hemorrhages.

The toolkit includes recommendations for training labor and delivery staff to recognize and treat hemorrhages, including formal protocols and checklists; information about medical conditions that raise hemorrhage risk in pregnancy and birth; and directions for equipping a "hemorrhage crash cart" with supplies for hemorrhage treatment, such as special sutures, intra-uterine compression balloons, lights and instruments, and medications.