Stopping the bleeding
Calif. collaborative targets maternal hemorrhage
While most qualityimprovement efforts in obstetrics focus on improving outcomes for babies, a statewide collaborative in California concentrates on mothers.
Launched in 2004, California Maternal Quality Care Collaborative’s qualityimprovement projects include an ongoing effort to reduce deaths and medical complications resulting from maternal hemorrhage.
“There are some causes of maternal mortality that you can’t do much about, but hemorrhage has a high degree of preventability,” says Elliott Main, chairman of obstetrics quality and safety for Sutter Health and director of the California Maternal Quality Care Collaborative, Stanford, Calif.
Hemorrhage occurs in about 5% of births, and about one out of every 10 of those cases is severe, Main says.
That’s why the California collaborative created a comprehensive, evidence-based process, which 30 hospitals throughout the state implemented in 2009. As of September 2010, clinicians had used the new protocols in 110,000 births.
The idea is to identify hemorrhage early and treat it aggressively to prevent bad outcomes. To do so, clinicians measure the amount of blood a mother loses. They also monitor vital signs, such as blood pressure.
When the first signs of hemorrhage appear, clinicians react quickly, using a systematic process, beginning with targeted medications and other measures. If necessary, they move on to blood transfusions, using what Main describes as “whole blood”—not the blood products typically stored in blood banks.
A comprehensive tool kit and educational webinars are available online at cmqcc.org.