Blood transfusions are among the most common medical procedures at US hospitals. In this case, however, more is not always better.
The Need for Blood Management
Blood transfusions are often necessary lifesaving procedures, but hospitals must be careful of overusing transfusions when unnecessary. The inefficient use of blood transfusions is both risky and wasteful. Transfusions bring higher risks of mortality and other dangerous complications. They are also costly. The direct cost of one unit of red blood cells is $200 on average, but there are numerous supplemental costs such as the transportation, testing, inventory management and storage of the blood. A 2010 study published by Transfusion, a peer-reviewed academic journal, estimated that blood transfusion costs actually range from $522 to $1,183 per unit of blood. Additionally, transfusions can impact the length of stay for a patient if infections or complications occur, driving costs up further. If a hospital is not careful in its management of blood transfusions, it can rack up hundreds of thousands of dollars per year of unnecessary added costs.
Characteristics of Effective Blood Management Programs
In today’s value-based, cost-sensitive healthcare market, an effective blood management program can help hospitals lower costs and improve quality of care.
The first component of these programs is the establishment of standardized guidelines that help doctors determine whether a transfusion is necessary or avoidable. National blood transfusion protocols do not exist, so hospitals are responsible for developing and propagating their own guidelines. Necessary guidelines include developing a standard order to transfuse, mandating that transfusion orders be required and documented during all surgeries, setting acceptable pre-transfusion blood lab values and creating a consistent informed consent process for patients that may encounter a transfusion.
Once hospital-wide transfusion guidelines are defined and implemented, applying some of the blood management strategies recommended by the Society of Cardiovascular Anesthesiologists (SCA) and Society of Thoracic Surgeons (STS) can help build out a comprehensive multimodal blood conservation program. Some of those strategies include:
- Working with cardiologists before surgery to make sure the patient is not on unnecessary doses of blood thinners and to ensure anemic patients have the proper pre-op medicine
- Carefully rationing IV fluids so the patient’s blood concentration does not drop unnecessarily during surgery
- Drawing a unit of blood from the patient the day of surgery, in case it is needed
- Reducing the amount of plumbing in the heart/lung machines so that they use less blood-diluting fluids
- Standardizing the way anti-bleeding medications are given during surgery
Education is also a critical component of an effective blood management program. Hospital staff need to be fully informed about the risks, benefits and alternatives to transfusions. Education helps doctors and staff achieve a patient-centered decision making model that is integral to quality improvement.
Example of a Successful Blood Management Program
A Sheridan anesthesiologist, Dr. Robert Brooker, initiated a blood conservation program to improve the transfusion rates at Memorial Regional Hospital in South Florida. The hospital started following an established protocol in 2008 and conducted a five-year study of the results of more than 1,000 patients. Over the span of those five years, Memorial Regional Hospital was able to:
- Reduce surgical transfusions in cardiac patients by 68%
- Reduce the amount of blood needed by 80%, saving the hospital $715.14 per unit
- Reduce the number of heart surgery-related deaths, infections, strokes and re-operations by 50%
- Reduce infections by 100%
These reductions have helped earn Memorial Regional Hospital its current 3-star rating from the Society of Thoracic Surgeons (STS), the highest rating awarded by the organization.
Transfusions will always be necessary on some level. A blood management program is not aimed to reduce these procedures across the board, but rather to target where transfusions may be unnecessary and might actually be putting patients at risk. As Dr. Brooker explained, “Blood transfusions in heart surgery, or anywhere, are only good for you if you really need it.”