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:

Women with anemia twice as likely to need transfusion after cesarean delivery
Pregnant women with anemia are twice as likely to need blood transfusions after a cesarean delivery, as those without the condition, according to a study being presented at the ANESTHESIOLOGY® 2019 annual meeting.
Are blood donor sex, pregnancy history and death of transfusion recipients associated?
Whether blood donors' sex and pregnancy history were associated with death for red blood cell transfusion recipients was investigated in this study that analyzed data from three study groups totaling more than 1 million transfusion recipients.
Red blood cell donor pregnancy history not tied to mortality after transfusion
A new study has found that the sex or pregnancy history of red blood cell donors does not influence the risk of death among patients who receive their blood.
Blood transfusion during liver cancer surgery linked with higher risk of cancer recurrence and death
Receiving a blood transfusion during curative surgery for the most common type of liver cancer (hepatocellular carcinoma) is associated with a much higher risk of cancer recurrence and dying prematurely, according to new research being presented at this year's Euroanaesthesia congress.
Impeding white blood cells in antiphospholipid syndrome reduced blood clots
A new study examined APS at the cellular level and found that two drugs reduced development of blood clots in mice affected with the condition.
Study: Denosumab effective in treating osteoporosis in transfusion dependent thalassemia
For patients with osteoporosis caused by transfusion-dependent thalassemia (TDT), a twice-yearly injection appears to improve spinal bone mineral density, according to a new study.
World's largest transfusion study in cardiac surgery changes transfusion practices
Lower thresholds for blood transfusions for cardiac surgery patients compared to traditional thresholds provide positive patient outcomes and safety at six months after surgery, according to the world's largest research study on this topic.
Gastrointestinal flora -- the culprit for severe lung damage after blood transfusion
Knowledge that the gastrointestinal flora affects both healthy physiological processes and various disease mechanisms has increased in recent years.
Does having a blood transfusion before, during or after surgery increase the risk for a blood clot?
A transfusion of red blood cells before, during or after surgery was associated with an increased risk of blood clots for patients.
Bristol researchers use gene editing to improve red blood cell transfusion compatibility
Synthetic biologists at the University of Bristol have succeeded in generating laboratory-made red blood cells with rare blood group types that could one day be used to help patients who cannot be matched with donor blood.
More Blood Transfusion News and Blood Transfusion Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

In & Out Of Love
We think of love as a mysterious, unknowable force. Something that happens to us. But what if we could control it? This hour, TED speakers on whether we can decide to fall in — and out of — love. Guests include writer Mandy Len Catron, biological anthropologist Helen Fisher, musician Dessa, One Love CEO Katie Hood, and psychologist Guy Winch.
Now Playing: Science for the People

#543 Give a Nerd a Gift
Yup, you guessed it... it's Science for the People's annual holiday episode that helps you figure out what sciency books and gifts to get that special nerd on your list. Or maybe you're looking to build up your reading list for the holiday break and a geeky Christmas sweater to wear to an upcoming party. Returning are pop-science power-readers John Dupuis and Joanne Manaster to dish on the best science books they read this past year. And Rachelle Saunders and Bethany Brookshire squee in delight over some truly delightful science-themed non-book objects for those whose bookshelves are already full. Since...
Now Playing: Radiolab

An Announcement from Radiolab