Photo courtesy of UAB Hospital
SAN DIEGO—Blood management guidelines can save millions of dollars and drastically reduce the waste of donated blood, according to a group of investigators.
A team at Vanderbilt University Medical Center in Nashville, Tennessee, developed blood utilization practice guidelines that resulted in $2 million in savings and a 30% reduction in blood use from 2011 to 2015.
The investigators presented these results in a poster at the 2016 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) Conference.
“The transfusion committee at Vanderbilt was interested in evaluating how we could implement evidence-based guidelines around restrictive transfusion,” said investigator Barbara J. Martin, RN.
To that end, the team first decided to change the standard practice of ordering 2 units of blood per patient. The investigators modified the medical center’s computerized provider order entry system to allow for blood ordering to be based on a specific assessment of each case, rather than a standard order of 2 units.
This change reduced red blood cell transfusions by more than 30%—from 675 units per 1000 discharges in 2011 to 432 units per 1000 discharges in 2015.
The investigators also noted that, 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.
In comparison, 11% of such patients were transfused with an average of 4.6 units of blood per patient in 2011.
“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.
In addition to addressing blood utilization, the investigators developed guidelines to reduce waste. These guidelines state that, when more than 1 unit of blood is ordered, it must be sent in a cooler rather than the pneumatic tube. Coolers were reconfigured to optimize temperature management.
Furthermore, a specific member of the staff is tasked with “ownership” of the blood products, including returning unused product to the blood bank. Finally, individual unit wastage is reported to clinical leaders for review, and aggregate data are reported monthly.
The use of these guidelines resulted in fewer than 80 units of blood being wasted in 2015, down from 300 units in 2011.
Martin said the guidelines she and her colleagues developed could easily be implemented at other medical centers.
“Blood is a limited resource,” she noted, “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.”
