Bleeding Detection
Risk and Cost of Undetected Bleeding
In addition to assisting with transfusion management, continuous SpHb can also help clinicians inside and outside the operating room monitor and detect internal bleeding. Bleeding affects up to 35% of patients in surgery, intensive care, and obstetric care areas.1 Bleeding is considered a significant risk factor for patients, and late detection further increases risk and cost.2 Surveys show that the majority of US hospitals have multiple patients per year with serious injury or death due to late detection of bleeding.3
Post-partum Hemorrhage
Every 90 seconds around the world, a woman dies from complications related to pregnancy or childbirth.4 For every woman who dies, 30 more suffer injuries or disabilities.5 Bleeding in obstetric patients, known as post-partum hemorrhage, affects 3% of mothers giving birth in the US6 and worldwide, is the #1 cause of maternal mortality.7 The Joint Commission has issued a sentinel event alert on post-partum hemorrhage, calling on hospitals to develop specific protocols to systematically detect bleeding to allow earlier intervention.8 Unfortunately, previous efforts have failed to make significant progress.
Limitations of Current Approaches to Detect Bleeding
A significant number of injuries or deaths due to bleeding are preventable. Prevention requires identifying that a patient has experienced significant bleeding and then intervening to stop the bleeding and improve the patient's condition. Identifying bleeding is challenging because even during surgery and childbirth, clinical estimation of blood loss is inaccurate and changes in standard vital signs can occur long after the bleeding has begun. Low hemoglobin identifies bleeding over 90% of the time, but is only assessed intermittently and requires a blood draw and laboratory analysis.9 In some parts of the world, laboratory testing is simply not available.
Potential for Earlier Identification of Falling Hemoglobin Values
Noninvasive and Continuous Hemoglobin Monitoring to Detect Bleeding
By measuring hemoglobin continuously, clinicians can become aware of real-time drops in hemoglobin that are indicative of bleeding. Identification of low or falling hemoglobin levels allows interventions that may prevent preventable death and disability.
Cost Savings Model from Capgemini
Capgemini, a leading supplier of global consulting and technology services, released a study showing that a typical 500 bed hospital incorporating Masimo rainbow® Pulse CO-Oximetry into its clinical standards and care pathways could generate nearly $500,000 in net annual cost savings and financial gains. Capgemini reported that significant financial benefits could be derived from incorporating noninvasive total hemoglobin (SpHb) by helping clinicians prevent unnecessary blood transfusions, identify internal bleeding, and increase patient throughput. The study concluded that "whether considered on a per-patient, department, or hospital-wide analysis, there are significant clinical and financial benefits to implementing Pulse CO-Oximetry technology."
The Capgemini whitepaper explains the study findings and cost savings calculations by care area. The Capgemini calculator allows a hospital to create customized calculations for the cost savings from SpHb monitoring by using their own inputs for surgery, intensive care, and the emergency department.
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Calculator: SpHb Capgemini |
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Whitepaper: Capgemini |
REFERENCES
- 1 Hebert PC. Crit Care. 1999: 3(2):57-63.
- 2 Herwaldt LA. Infect Control Hosp Epidemiol. 2003; 24(1):44-50.
- 3 HRA Research of Hospital Executive. 2012.
- 4 Maternal Mortality in 2005: WHO, UNICEF, UNFPA and the World Bank.
- 5 UNICEF Statistic, 2003.
- 6 Bateman BT et al. Anesth Analg May 2010 110:1368-1373.
- 7 Khan KS et al. WHO. 2006. 367:1066-1074.
- 8 The Joint Commission, "Sentinel Event Alert: Preventing Maternal Death" Issue 44, January 26, 2010.
- 9 Bruns B et al. J Trauma. 2007; 63(2):312-5.
