"We know that there is a lack of knowledge," said Dr. Aryeh Shander, chief of the department of anesthesiology and critical care medicine at Englewood Hospital and Medical Center in New Jersey, who headed up the transfusion work group.
Dr. Aryeh Shander
Medical schools devote only about 2-6 hours to the subject of blood transfusion, and most of that time is spent on blood type compatibility, not only the clinical situations in which blood transfusion is appropriate, said Dr. Shander, who is also the president of the Society for the Advancement of Blood Management, a group that advocates for reducing the number of blood transfusions.
"This is one of the 10 most common invasive procedures done in hospitalized patients," Dr. Shander said. "I don’t think you would want a cardiac surgeon doing heart surgery on you with 6 hours of education."
While it is well known that blood transfusions run the risk of complications, there is also a growing body of literature showing that transfusions don’t improve outcomes in patients who are regularly transfused, such as nonhemorrhaging patients and those who don’t have a functioning bone marrow, Dr. Shander said.
"The problem is that for physicians, the default is to transfuse," he said. "If there’s a question, they default to transfuse rather than looking at other options for patients, which are just as effective and carry less risk."
When physicians rush to transfuse, they deprive patients of better options, he said. For example, a patient with very low hemoglobin who is completely stable is likely to be transfused in many hospitals. But Dr. Shander said that patient is more likely to need iron.
Hitting Rock Bottom on PCI Overuse
When it comes to percutaneous coronary intervention, the experts at the National Overuse Summit were trying to figure out how to bring down an already low number.
Dr. Carl T. Tommaso
Current estimates put the amount of overuse of the procedure at about 6-8% nationally, according to Dr. Carl T. Tommaso, an interventional cardiologist at NorthShore University HealthSystem in Skokie, Ill., who headed up the PCI work group.
The amount of overuse is so low because the field already has guidelines, appropriate use criteria, and a national database for reporting outcomes.
"What’s rock bottom?" Dr. Tommaso said. "We don’t know what those numbers are."
But Dr. Tommaso and the members of the PCI work group said the best path forward is to continue to push physicians to use the appropriate use criteria to guide their decisions on PCI.
"With the appropriate use criteria, and people using them, we will move toward better use of PCI for our patients," Dr. Tommaso said.
The Joint Commission and the AMA–convened Physician Consortium for Performance Improvement are currently analyzing results from the National Overuse Summit, and each of the five work groups is working on potential next steps.