Nav: Home

Blood management guidelines can reduce blood wastage and save millions of dollars

July 17, 2016

SAN DIEGO: Improving the processes of ordering, transporting, and storing blood can save millions of dollars and drastically reduce blood wastage, reported a research team from one academic medical center after implementing institutional initiatives to address blood management. The multidisciplinary team at Vanderbilt University Medical Center, Nashville, Tenn., developed blood utilization practice guidelines that resulted in $2 million in savings and a 30 percent reduction in blood utilization, according to a poster presentation at the 2016 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) Conference in San Diego.


"The transfusion committee at Vanderbilt was interested in evaluating how we could implement evidence-based guidelines around restrictive transfusion," according to lead study author Barbara J. Martin, MBA, RN.


The first step the team at Vanderbilt took to better utilize blood transfusion practices was to change provider orders to support a single unit and then follow up and order more blood if necessary. The previous standard process was to initially order two units of blood, which is not always needed. Study authors noted that it is common practice at many hospitals to reflexively order a transfusion based on habit, rather than assessment.


According to study authors, blood transfusions increase the risk of complications--including transfusion reaction, infection, volume overload, increased length of stay, and, even, mortality--associated directly and indirectly with the transfusion.


"The data on restrictive transfusion has been out for years documenting that patients have better outcomes with a more restrictive transfusion strategy. 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," Ms. Martin said.


By enhancing the Computerized Provider Order Entry (CPOE), the research team allowed for blood ordering practices to be based on a specific assessment of each case rather than a standard order of two units. By revising CPOE, Vanderbilt was able to reduce red blood cell 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.


Study authors reported that for general and vascular surgery patients who underwent NSQIP targeted procedures--including colectomy, proctectomy, ventral hernia, and appendectomy--between 5 and 6 percent were transfused with an average of 2.4 units of blood per patient in 2015, compared with 11 percent transfused with an average of 4.6 units of blood per patient in 2011.


"With regard to surgical populations, one of the questions we had with our NSQIP data, where we track the number of units patients receive in the perioperative time period, was whether we would see similar decreases in blood utilization in the NSQIP population," said Ms. Martin. "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."


In addition to addressing blood utilization, the Vanderbilt team also looked at how to reduce blood wastage. To reduce inefficiencies in the ordering, transport, and storage of blood, the team developed guidelines for perioperative handling:
  • 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 in blood utilization at Vanderbilt resulted in fewer than 80 units of blood being wasted in 2015, down from 300 in 2011.


Ms. Martin said that the guidelines they developed could easily be implemented at other medical centers. However, she noted, "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. Any incremental improvement would take additional resources."


"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," according to study coauthor Oscar Guillamondegui, MD, FACS, associate professor of surgery and Vanderbilt's NSQIP Surgeon Champion.


Beyond the benefits for an individual medical center of reducing blood wastage and utilization, Ms. Martin said there are also broader implications for the way blood donations are viewed. "Blood is a limited resource 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," she said. She also noted that using blood more effectively could have the ability to reassure donors that their blood is being used as sensibly and appropriately as possible.


Ms. Martin said that the efforts at Vanderbilt to optimize blood utilization were possible because of their multidisciplinary team approach. Involved in the project were administrative leadership, executive leadership, nursing staff, physicians, and house staff, among others.
-end-
Other study authors are: Marcella Woods, PhD; Pampee P. Young, MD, PhD; Garrett S. Booth, MD, MS; and Gina Whitney, MD.


"FACS" designates that a surgeon is a Fellow of the American College of Surgeons.


About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit http://www.facs.org.

American College of Surgeons

Related Blood Transfusion Articles:

Assay of clotting ability accurately predicts need for transfusion in trauma patients
By combining a conventional laboratory measurement of blood clotting time (known as the International Normalized Ratio or INR) with a new test of blood clot strength, based upon thrombelastography (TEGĀ®), researchers at the University of Colorado's Department of Surgery, Denver, are able to quickly and efficiently assess the overall ability of blood to clot and identify trauma patients who were most in need of a massive blood transfusion.
Researchers use modified insulin and red blood cells to regulate blood sugar
Researchers have developed a new technique that uses modified insulin and red blood cells to create a glucose-responsive 'smart' insulin delivery system.
Broadly adopted transfusion practice may not benefit patients without traumatic injury
A study from investigators at Massachusetts General Hospital finds that a blood transfusion practice previously studied only in patients with severe traumatic injuries has been widely adopted within the hospital for surgical patients without traumatic injuries, for whom it may not be beneficial.
Blood test for prion disease could make blood supply safer
A blood test accurately diagnosed a total of 32 patients with a rare form of prion disease, two new analyses report, offering a potentially valuable tool for preventing prion contamination of the blood supply.
Expert panel issues updated guidelines for red blood cell storage time and transfusion use
For most stable hospitalized patients, transfusions of red blood cells stored for any time point within their licensed dating period -- so-called standard issue -- are as safe as transfusions with blood stored 10 days or less, or 'fresh,' according to updated clinical guidelines issued by an expert panel convened by a national organization that has long set standards for blood banking and transfusion practices.
Updated AABB guidelines for when to perform red blood cell transfusion, optimal length of RBC storage
In a report published online by JAMA, Jeffrey L. Carson, M.D., of Rutgers Robert Wood Johnson Medical School, New Brunswick, N.J., and colleagues provide recommendations for the AABB (previously known as the American Association of Blood Banks) for the target hemoglobin level for red blood cell (RBC) transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion.
'Fixing' blood vessel cells to diagnose blood clotting disorders
A new device developed at the Wyss Institute for Biologically Inspired Engineering could monitor blood clot formation and diagnose effectiveness of anti-platelet therapy by microengineering tiny hollow channels lined by chemically 'fixed' human endothelial cells that more closely mimic cellular and vascular flow conditions inside a patient's body than a bare surface.
New technique uses electrical conductivity to measure blood in dry blood spot analysis
Researchers from The University of Texas at Arlington have demonstrated that electrical conductivity can be an effective means to precisely measure the amount of blood present in dry blood spot analysis, providing a new alternative to the current preferred approach of measuring sodium levels.
Blood management guidelines can reduce blood wastage and save millions of dollars
Improving the processes of ordering, transporting, and storing blood can save millions of dollars and drastically reduce blood wastage, reported a research team from one academic medical center after implementing institutional initiatives to address blood management.
Researchers find association between donor age, female sex and transfusion outcomes
A large Canadian study has shown a link between blood donor characteristics and transfusion recipients' outcomes.

Related Blood Transfusion Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...