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Better Blood Use, Better Outcomes

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   March 29, 2013

This article appears in the March 2013 issue of HealthLeaders magazine.

What simple shift in acute care practice can reduce patients' adverse events, cut lengths of stay, drop hospital costs by millions of dollars a year, and even prevent mortality? Not to mention save a precious human resource that may become more scarce within the next decade?

Look no further than patient blood management and a significant shift in blood transfusion service operations.

By reducing the point at which doctors initiate transfusion, called the hemoglobin trigger, from 8 g/dl to 7 in stable medical or surgical patients, and by not transfusing patients who don't really require it or not transfusing more than needed, healthcare leaders are finding significant savings without any negative effect on patient outcomes.

"Here we are, almost seven years down the road from our base year in 2006, and we're now spending half as much on blood acquisition, even though our patient volume and our patient acuity have increased," says Irwin Gross, MD, medical director of transfusion services and patient blood management at 411-bed Eastern Maine Medical Center in Bangor.

The 58% reduction in units purchased means that instead of $3.5 million a year, the hospital and its Level II trauma center serving 400,000 people as far as the Canadian border, spends only $1.6 million buying blood. Since 2006, Gross says, the hospital has spent $8 million less on blood acquisition, and that doesn't count the associated expenses of typing and cross-matching products inside the hospital.

Those savings also don't include the avoided costs of caring for patients with potentially fatal adverse outcomes resulting from transfusions, such as transfusion-related acute lung injury, transfusion-associated circulatory overload, or hemolysis. Gross estimates the cumulative risk of such events is at least 1% of patients who receive a transfusion.

"What we do know is that when we transfuse less, lengths of stay go down, hospital-acquired infection rates go down," Gross says. "Cases of new onset of acute renal failure and peri-surgical acute myocardial infarction rates are lower now that we have patient blood management." 

These PBM savings are especially notable given that EMMC's pretransfusion hemoglobin trigger points were already comparatively low, an average of 8 g/dl, Gross says, "quite conservative relative to what others were doing; we didn't think we were overtransfusing."



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