By implementing institution-wide initiatives around blood management, an academic medical center reports saving millions of dollars and dramatically reducing blood wastage.

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The team says using blood more effectively reassures donors that we are making best use of their donations.

Vanderbilt University Medical Center in Nashville, TN, say they reduced blood use by 30 percent and saved $2 million after implementing new practice guidelines on blood utilization that they developed themselves.

A study on the work features in a poster session titled "Blood Management: Optimizing Use of Scarce Resources," during the 2016 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Conference in San Diego, CA, July 16-19.

Lead author Barbara J. Martin, MBA, RN, a member of the Vanderbilt Center for Clinical Improvement, says:

"The transfusion committee at Vanderbilt was interested in evaluating how we could implement evidence-based guidelines around restrictive transfusion."

Martin and colleagues note that blood transfusions raise the risk of transfusion reaction, infection, longer hospital stays, and even death, and there is evidence that a restrictive transfusion strategy - as opposed to a liberal one - results in better outcomes for patients.

"We were looking at whether we could guide providers to treat symptomatic anemia with a single unit of blood rather than the usual two units," says Martin.

Red blood cells for transfusion reduced by 30 percent

The first part of the blood management system the team addressed was the ordering process. They changed provider orders from the standard practice of ordering two units, to one of ordering one unit then following up with a further order if needed.

The team says many hospitals commonly order a transfusion based on habit rather than individual assessment.

By changing their blood ordering practices to be more specific, Vanderbilt reduced usage of red blood cells for transfusions by more than 30 percent - from 675 units per 1,000 discharges in 2011 down to 432 units per 1,000 discharges in 2015.

The team also looked at the blood patients receive in the period surrounding their operation. Some of the patients are included in the hospital's NSQIP system.

NSQIP is a quality improvement tool for helping hospitals measurably improve surgical patient outcomes.

The team found that data collected on general and vascular surgery patients who underwent NSQIP-targeted procedures showed a reduction from 11 percent transfused with an average of 4.6 units of blood per patient in 2011, to 5-6 percent transfused with an average of 2.4 units per patient in 2015.

The patients had undergone procedures that included colectomy, proctectomy, ventral hernia, and appendectomy.

Martin says they found in NSQIP-targeted surgical patients, many of whom are transfused for acute blood loss, they still saw "a significant decrease in the number of units transfused into the patient."

Reduced blood wastage

As well as looking at blood usage, the team also implemented measures to reduce blood wastage across the whole system. These included specific changes, for example:

  • When ordering more than one unit of blood, have it sent in a cooler rather than a pneumatic tube
  • Reconfigure coolers to ensure blood transported at optimum temperature
  • Have blood products "owned" by specific members of staff - these "owners" responsible for returning unused product to the blood bank
  • Ensure clinical leaders review individual blood unit wastage - collect overall data and report it monthly.

The collective effect of these measures reduced blood wastage at Vanderbilt from 300 units in 2011 down to 80 units in 2015.

Martin says the changes they made could also work in other medical centers. You have to prioritize the initiatives, she notes, and explains they had opportunities to make huge gains in blood transfusion and blood wastage. "Any incremental improvement would take additional resources," she adds.

The improvements go beyond the hospital - they also affect how blood donations are viewed. "Blood is a limited resource," says Martin, "and we have a responsibility as a health care provider to optimize the use of a resource that is difficult to get and only available through altruistic donations."

By using blood more effectively, it reassures donors that we are making best use of their donations, she adds.

Martin also attributes much of their success at Vanderbilt to the fact they had a multidisciplinary team, drawn from all levels and hospital areas affected.

"We were able to change the mindset of the entire institution, initially, and then determine that the improved usage with decreased wastage was beneficial to patient outcomes is a huge success for the team, the institution, and most importantly, the patients."

Prof. Oscar Guillamondegui, Vanderbilt NSQIP Surgeon Champion

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