By implementing guidelines for the perioperative handling of blood, researchers have successfully reduced blood use and waste.
An evidence-based blood management initiative devised by a multidisciplinary team at Vanderbilt University Medical Center in Nashville, TN has saved $2 million and reduced blood use by 30% at the academic medical center.
The program, which focuses on improving the processes around ordering, transporting and storing blood, was presented this week at the 2016 American College of Surgeons National Surgical Quality Improvement Program Conference in San Diego.
In a media release detailing the initiative, VUMC researchers noted that many hospitals reflexively order a transfusion based on habit, rather than assessment.
With that in mind, the first step for the initiative was to change the standard process of initially ordering two units of blood, which is not always needed.
Instead, researchers used an enhanced Computerized Provider Order Entry (CPOE) to support a single unit, based on a specific assessment of each case, and then followed up and ordered more blood when necessary.
That step allowed VUMC to reduce red blood cell transfusions by more than 30%—from 675 units per 1,000 discharges in 2011 down to 432 units per 1,000 discharges in 2015.
Study lead author Barbara J. Martin, MBA, RN, said that reducing the numbers of blood transfusions also reduces the risk of complications—including transfusion reaction, infection, volume overload, increased length of stay, and death.
"The data on restrictive transfusion has been out for years documenting that patients have better outcomes with a more restrictive transfusion strategy," Martin said in remarks accompanying the presentation.
"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."
For general and vascular surgery patients who underwent NSQIP targeted procedures—including colectomy, proctectomy, ventral hernia, and appendectomy—between 5% and 6% were transfused with an average of 2.4 units of blood per patient in 2015, compared with 11% transfused with an average of 4.6 units of blood per patient in 2011.
Reduced Blood Waste
"We found that in that particular population, many of whom are transfused for acute blood loss, we still saw a significant decrease in the number of units transfused into the patient," Martin said.
The VUMC team also reduced blood wastage correcting inefficiencies in the ordering, transport, and storage of blood, such as:
- When more than one unit of blood is ordered, it is sent in a cooler rather than the pneumatic tube.
- Coolers were reconfigured to optimize temperature management.
- A specific member of the staff is tasked with "ownership" of the blood products, including returning unused product to the blood bank.
- Individual unit wastage is reported to clinical leaders for review; aggregate data are reported monthly.
The improvements resulted in fewer than 80 units of blood being wasted in 2015, down from 300 in 2011.
Martin said that the guidelines developed at VUMC could easily be implemented at other hospitals. "You have to prioritize what your initiatives are. At Vanderbilt, we had a lot of opportunities with blood transfusion and blood wastage and we made huge gains," she said. "Any incremental improvement would take additional resources."
The initiative also addresses broader implications for the way blood donations are viewed, Martin said.
"Blood is a limited resource and we have a responsibility as a healthcare provider to optimize the use of a resource that is difficult to get and only available through altruistic donations," she said.