Hospitals cutting back on blood utilization

There appears to be a direct link between hospitals’ initiatives to improve blood use stewardship and a 20 percent decrease in blood utilization for 134 diagnoses which make up 80 percent of red blood cell usage.

According to a Premier whitepaper on 27 million discharges at 645 hospitals between 2011 and 2016, there was a greater drop-off of 40 percent when isolating the ten procedures which use the most blood. Other procedures saw further declines, such as 72 percent reduction in joint replacement patients receiving transfusions and a nearly 24 percent reduction for large and small intestinal procedures for patients with chronic conditions.

“During this same period, when compared with quality data, trends suggest that reduced blood utilization didn’t negatively impact patient outcomes – as rates of mortality, complications and readmissions also fell,” the analysis said. “These significant decreases of unnecessary blood utilization are a direct result of provider-led efforts to optimize care who are improving use of this costly commodity and employing evidence-based practices.”

Blood transfusions can cost about $1,000 per unit after factoring for indirect expenses like transport, according to Premier, and as of 2011, accounted for about 51,000 adverse events annually, including allergic reactions, fever, lung injury, immune suppression and renal injury.

An effective blood management program saved millions of dollars for several facilities working with Premier, such as:

• BayCare Health System in Tampa, Fla.: A blood management campaign—including marketing slogans like “Why Give Two When One Will Do?”—along with new practice guidelines led to 54,000 fewer units of blood being used, a 54 percent reduction.
• Mercy Health in Cincinnati, Ohio: Blood transfusions cost its 22 acute care facilities $26 million in 2012. With new blood use protocols, usage dropped by 70 percent over a three-year period, saving the system $6.2 million.
• Carle Foundation Hospital in Urbana, Ill.: Red blood cell use was higher than average, being used in 10 percent of all admissions. By finding areas of overuse in each department—like getting geriatric and obstetrical management to treat anemia with iron supplements—5,000 fewer transfusions were needed after two years, saving the hospital nearly $2 million.

Premier emphasized getting buy-in from clinical staff for these efforts and understanding why an individual hospital or department may order more transfusions so that behavior can be changed.

“While there remain opportunities for improvement, the staggering declines in blood use in a little over five years is a major step in encouraging all hospitals and health systems to enhance blood use and foster an effective hospital transfusion culture,” the analysis concluded.