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Blood Use, Quality, and Cost

Cheryl Clark, for HealthLeaders Media, March 13, 2013
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"I think what's going to happen fairly soon is that the rest of the country is going to catch on," he says.

Gross, former president of the EMMC medical staff, recognized the problem while reading peer-reviewed studies showing "that risks of transfusion had been underestimated, underreported, and underrecognized, and that the evidence for benefit, except in settings of acute blood loss, really wasn't there. We had misinterpreted the literature." Yet the practice persisted throughout the country from a time "when a hemoglobin of 10 g/dl was felt to be an appropriate transfusion trigger."

Changing the transfusion mind-set, he says, was much more than just telling doctors to hold back before deciding to transfuse. "It was also about working across disciplines to make sure patients rarely get into a situation where they need to be considered for a transfusion—even something as seemingly insignificant as minimizing phlebotomy blood loss for lab testing" when it isn't really necessary.

What is increasingly clear is how variable each hospital's blood transfusion practices are, even down to each surgeon, regardless of specialty.

Healthcare improvement alliance Premier last year announced an analysis of blood use variation among 464 hospitals. It found that if all 464 had implemented blood protocols similar to those in the top performing 25%, the bottom 75% could save 802,000 units and $165 million could be saved a year without a decline in patient outcomes.

Executives with both the AABB and America's Blood Centers, which represent blood banks and transfusion professionals, agree that too much blood is wasted.

"Doctors often give patients blood just because they look a little anemic in the belief that if they 'pink up,' they'll do better," says Jim MacPherson, CEO of America's Blood Centers, whose members operate 600 donor centers for 3,500 North American hospitals. Unnecessary use, he says, is estimated to be between 10% and 50%. "Easily it's 10%, and probably closer to 20%."

Blood is getting so tough for blood banks to collect and hospitals to process that "we see disaster coming in a few years in terms of our ability to supply blood," says MacPherson. First, as people age, their medical conditions or medications, such as blood thinners, may disqualify them from donating. "In the mid-'90s, 60% of the U.S. population was eligible to be a donor, but today that's less than 40%," he says.

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