Healthcare organizations have a wealth of choices when it comes to choosing quality and safety initiatives. One area that may be overlooked, however, is blood management. Timothy J. Hannon, MD, MBA, chief medical officer and founder of Strategic Healthcare Group and former medical director of St. Vincent Indianapolis Hospital's blood management program, shares four reasons why hospitals and health systems should consider blood management as a quality and safety improvement initiative, and three steps to get started on one.
Why blood management?
1. High volume. Blood transfusions are a high-volume procedure, making them an ideal target for reducing utilization, according to Dr. Hannon. In 2010, they were the most frequently performed procedure during hospital stays, according to a statistical brief from the Healthcare Cost and Utilization Project, and recent research at Johns Hopkins University found blood transfusions are overutilized, according to a study in Anesthesiology.
In fact, in February the Society of Hospital Medicine included a guideline for blood transfusion as part of the Choosing Wisely campaign, in which professional medical associations identify practices that may be overutilized. In addition, in October 2012, the American Medical Association and The Joint Commission's co-sponsored National Summit on Overuse focused on five treatments, including blood transfusion.
2. High risk. Blood transfusions also present a high risk to patients, as they are liquid transplants, causing a stress to the immune system, according to Dr. Hannon. Blood transfusions put patients at an increased risk for infections, such as sepsis and ventilator-acquired pneumonia, he says.
3. High cost. Blood is costly to buy and administer. The average cost of a unit of blood is approximately $200, but the total cost can be close to four times that due to the cost of labor and supplies, according to Dr. Hannon. If an adverse event occurs, the cost can rise to almost eight times the purchase cost, he says.
Reducing blood use can therefore save hospitals a significant amount. In 2001, Dr. Hannon implemented a blood management program at St. Vincent Indianapolis Hospital. Since then, the program has reduced transfusions by more than 30 percent, saving more than $4 million per year.
4. Wide variation. Not only are blood transfusions overused, highly risky and costly, they are also not standardized across physicians, according to Dr. Hannon. "If you look at a number of published studies, there is wide variation in transfusion practice across hospitals for similar patient groups. Within a given hospital, physicians in the same specialty also tend to use blood very variably," he says.
Getting started with blood management
Taken together, blood transfusions' high volume, risk, cost and variation give blood management high potential for making significant improvements in healthcare organizations. Here are three steps hospitals can take to get started on a blood management program:
1. Evaluate baseline. The first step is to evaluate the organization's current blood use, costs, variation and patient outcomes. "We recommend hospitals look internally first at their procedures — do they have oversight for blood utilization (a transfusion committee), are they measuring key metrics for utilization and safe, compliant use of blood products?" Dr. Hannon says. Organizations should compare their data against external benchmarks to determine their performance levels, he says.
2. Create a blood utilization committee. The next step is for organizations to identify best practices for blood utilization and establish systems to ensure these practices are followed. Dr. Hannon suggests hospitals create a multidisciplinary blood utilization committee of medical staff to develop guidelines for transfusions and ensure the guidelines are followed.
3. Execute best practices. Dr. Hannon suggests hospitals create working groups separate from the blood utilization committee that are responsible for executing clinical best practices. Working groups for specialties with the highest blood use, including cardiac surgery, orthopedic surgery, critical care, trauma, gastroenterology and oncology, can implement best practices in each of those specialties.
After establishing these groups, hospitals will ultimately have to gain buy-in from physicians and nurses to change practice, according to Dr. Hannon. But starting with these few steps can get hospitals started on the path toward safe, appropriate blood use.
"Blood management is the golden opportunity many hospitals are not aware of," he says. "They have a lot on their plate, but any time you can pull a single lever to make substantial improvements in cost and quality, you should strongly consider it. Blood transfusions are high volume, high risk, high cost and poorly utilized; it seems like the model process for hospitals under the new [healthcare reform] paradigm."
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