By implementing guidelines for the perioperative handling of blood, researchers have successfully reduced blood use and waste.
An evidence-based blood management initiative devised by a multidisciplinary team at Vanderbilt University Medical Center in Nashville, TN has saved $2 million and reduced blood use by 30% at the academic medical center.
The program, which focuses on improving the processes around ordering, transporting and storing blood, was presented this week at the 2016 American College of Surgeons National Surgical Quality Improvement Program Conference in San Diego.
In a media release detailing the initiative, VUMC researchers noted that many hospitals reflexively order a transfusion based on habit, rather than assessment.
With that in mind, the first step for the initiative was to change the standard process of initially ordering two units of blood, which is not always needed.
Instead, researchers used an enhanced Computerized Provider Order Entry (CPOE) to support a single unit, based on a specific assessment of each case, and then followed up and ordered more blood when necessary.
That step allowed VUMC to reduce red blood cell transfusions by more than 30%—from 675 units per 1,000 discharges in 2011 down to 432 units per 1,000 discharges in 2015.
Study lead author Barbara J. Martin, MBA, RN, said that reducing the numbers of blood transfusions also reduces the risk of complications—including transfusion reaction, infection, volume overload, increased length of stay, and death.
"The data on restrictive transfusion has been out for years documenting that patients have better outcomes with a more restrictive transfusion strategy," Martin said in remarks accompanying the presentation.
"We were looking at whether we could guide providers to treat symptomatic anemia with a single unit of blood rather than the usual two units."
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, compared with 11% transfused with an average of 4.6 units of blood per patient in 2011.