"In the fourth quarter of 2007, we had 400 episodes of transfusions in patients with a hemoglobin of greater than or equal to 9 g/dl, but in the third quarter of this year, there were just slightly over 100, and most of those were done because the patients were actively bleeding."
Joseph Prosser, MD, Texas Health Harris Methodist's chief medical officer, credits Fenderson for "determining that our blood usage seemed to be outside of national standards ... particularly on elective orthopedic cases."
The savings, they say, are probably much greater than the cost of the blood itself. The complex process of typing, cross-matching, and administering the blood within the hospital raises costs from about $200 paid to the blood bank to more than $1,000.
"More importantly, blood is dangerous if used inappropriately. It's an immune modulator, it increases the risk of infection, it can cause transfusion-related acute lung injuries, and certainly has historically transmitted other diseases," Prosser says.
"We've really had a tremendous improvement in the awareness and respect for use of blood at this hospital," he adds. "Every unit you don't transfuse when it's not needed protects the patient."
Fenderson says her strategy was to just show doctors how their ordering practices varied. She'd patiently explain that times had changed from when more blood was considered better. It wasn't always easy getting physicians to change their practice, she says.
"To say the least, I had some not too pleasant phone calls a few times. They would say, 'Who are you to question my ordering practices?' I tried to explain blood transfusions are really just liquid organ transplants, and just as you wouldn't perform a solid organ transplant because 'it wouldn't hurt,' you shouldn't be transfusing patients, especially when the benefits don't outweigh the risks."