Traditionally, hospital leaders considered blood transfusions a commonly needed therapy and an unavoidable cost. Today, however, patient blood management programs can help hospitals reduce and on many occasions eliminate the need for blood transfusions, which in turn can help improve patient outcomes while significantly reducing costs.
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Each year, approximately 5 million Americans receive blood transfusions, according to the National Heart, Lung, and Blood Institute. Mostly, these are patients who have experienced blood loss from an injury or surgery, or patients with certain illnesses such as anemia or hemophilia.
Traditionally, hospital leaders have considered blood transfusions a commonly needed therapy and an unavoidable cost of doing business. Today, however, patient blood management programs can help hospitals reduce and on many occasions eliminate the need for blood transfusions, which in turn can help improve patient outcomes while significantly reducing healthcare costs.
What is patient blood management?
According to the Society for the Advancement of Blood Management, PBM is the scientific use of safe and effective medical and surgical techniques designed to prevent anemia and decrease bleeding in an effort to improve patient outcomes. The AABB, or American Association of Blood Banks, more narrowly defines PBM as an evidence-based, multidisciplinary approach to optimizing the care of patients who might need a transfusion.
Basically, PBM is a set of strategies that can help hospitals reduce or eliminate the number of blood transfusions they perform by properly addressing the medical conditions of those patients.
One of many important strategies of PBM is optimizing patients prior to surgery. If a clinician can determine whether a patient is at increased risk for a transfusion before the procedure, then he or she can take steps to reduce the likelihood that a transfusion will be needed. Patients with anemia are prime examples of cases in which pre-surgery optimization can be most effective. Anemia, a condition marked by a deficiency of red blood cells, affects nearly 2 billion people worldwide, according to the World Health Organization. And research shows that anywhere from 30 to 40 percent of patients who undergo elective surgery are anemic.
Anemia is an independent risk factor for all sorts of complications, including increased risk of death. When clinicians test patients for anemia three to four weeks prior to surgery, they have time to identify the type of anemia (such as an iron deficiency) and treat it with various drug or hormone therapies to bring blood cell counts to normal levels and lower the likelihood of anemia-related complications as well as complications associated with a transfusion.
Additionally, PBM promotes blood conservation through techniques such as minimizing the number of times a patient's blood is drawn for testing prior to and after surgery — because repeated blood draws can lead to anemia resulting in unnecessary transfusions. PBM strategies also help minimize blood loss during procedures through the use of surgical devices and pharmaceutical agents that control bleeding, by managing anesthesia and fluids and by using techniques that salvage a patient's own blood.
Improving outcomes, lowering costs
Hospitals that implement PBM programs can achieve significant reductions in the number of transfusions they perform. For most facilities, a 20 to 30 percent reduction is common. Some hospitals with particularly aggressive goals have achieved reductions of 50 percent or more.
By lowering the number of avoidable transfusions, hospitals reduce the number of patients at risk for serious transfusion-related complications, such as potentially fatal transfusion reactions, infection, kidney failure and lung dysfunction. In addition to the obvious negative health impacts on patients, such complications also lead to extended lengths of stay and utilization of additional hospital resources, both of which increase costs.
But even without complications, transfusions are costly. According to a landmark study published in 2010, the average cost of transfusing one unit of red blood cells is $1,200. So if a PBM program can reduce transfusions by 20 to 30 percent, a hospital can expect significant savings. For example, a 500-bed hospital transfusing 4,000 units of red blood cells per year would save approximately $960,000 annually by reducing transfusions by 25 percent with a PBM program.
Role of the C-suite
Of course, hospitals should expect a ramp-up period for their PBM program before touting double-digit transfusion reduction rates. And creating a successful program can take time in terms of securing participation and buy-in from all appropriate stakeholder groups.
Because PBM requires a multidisciplinary approach, hospitals need active involvement from physicians (anesthesiologists, surgeons, etc.), nurses and technicians, as well as the hospital's C-suite and board of directors. In fact, earning C-suite buy-in may be most critical component of a PBM program's success. Support from top hospital leadership is necessary to provide legitimacy and importance to the initiative and provide the investment of resources required to get the program up and running.
With the proper buy-in and participation across service lines and leadership, hospitals can ensure the right people and methodologies are in place to achieve success. And in fact, most hospitals realize a return on their investment within the first year of launching a PBM program.
Conclusion
Blood transfusion is a common hospital therapy that comes with a set of risks and costs that often can be avoided through proper Patient Blood Management. By adopting strategies to optimize patients prior to surgery, conserve blood and minimize blood loss, hospitals can achieve improved patient outcomes while reducing costs.