Blood management guidelines save $2 million and reduce blood use 30%
At Vanderbilt University Medical Center (VUMC) in Tennessee, a multidisciplinary team has been working on evidence-based guidelines for limiting blood use and waste. Presenting its results at this year’s American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) conference, the team announced that its test program had saved the hospital $2 million and reduced blood use by 30%.
The VUMC researchers said in a press release that the first step was to get hospitals to assess how many units of blood are needed during a transfusion. Many facilities automatically order two units of blood for a transfusion, which isn’t always necessary.
Using an enhanced Computerized Provider Order Entry (CPOE), researchers were able to order a single unit of blood based on the merits of each case, with more blood ordered when necessary. That step alone cut VUMC’s red blood cell transfusions down from 675 units per 1,000 discharges to 432 units per 1,000 discharges over four years. In addition, researchers were able to reduce the amount of blood transfused during surgery from 4.6 units of blood per patient to 2.6 units.
"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 study author Barbara 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."
Some methods of reducing blood wastage include:
• 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.
Read more about blood management techniques at HealthLeaders Media.