Are You Using Too Much Blood? Curbing Unnecessary Blood Transfusions

Picture this: Your father goes in for a routine hip replacement surgery. Before he even enters the operating room, medical staff consult him on how to prepare. They discuss getting a physical, directions for eating and drinking prior to surgery, how the implant works, the post-discharge process and how to create an environment for optimal recovery. Unfortunately, left out of the conversation are the risks, such as unexpected hemorrhaging from a blood transfusion that may or may not be necessary.

As a patient, you do not want a blood transfusion unless it’s absolutely necessary. Yet, few understand the risks associated with blood transfusions during hip replacement and other procedures. While blood can save lives during surgery or trauma, it can also increase the risk for adverse events, such as a major allergic reaction, immune suppression or even death. Additionally, blood transfusions can have significant financial and quality implications. Costing upwards of $1,000 per unit, transfusions have been associated with a 66 percent increased risk of mortality.

Blood use can be a dual-edged sword, and protocols and practices vary significantly across hospitals and departments. Any two patients receiving the same surgery may or may not receive a transfusion, depending on a provider’s culture around blood use. In fact, estimates suggest that approximately 40 percent of the blood and blood products administered in the U.S. may be unnecessary.

As more research on the safety and cost of blood use has come to light, hospitals have focused on optimizing their blood use practices. A Premier analysis found nearly 650 hospitals decreased blood utilization by 20% across 134 diagnoses that account for 80% of red blood cell transfusions. Essentially, these hospitals have cut blood use in half for procedures that regularly require transfusions.

For example, Carle Foundation Hospital in Illinois was able to decrease the number of blood transfusions by 35%, generating $2 million in savings over a two-year period. Another hospital in Ohio realized $6.2 million in savings over a three-year period as a result of conserving red blood cell, platelet, plasma and cryo use in both inpatient and outpatient facilities.

So, what’s the secret sauce? Three key elements are crucial to move these efforts forward.

1. Make data your foundation: Managing blood use is challenging without strong data and analytics to measure total utilization rates and compare against quality outcomes and peer benchmarks. Consistent data measurement helps providers pinpoint opportunity areas and enhance blood use stewardship.
2. Educate all provider stakeholders: Making sure to communicate with physicians, anesthesiologists and other relevant departments is vital to the success of optimizing blood use. Garnering feedback on guideline development, holding practice reviews and using evidence-based clinical decision support tools with real-time alerts for blood orders help to keep clinicians and caregivers educated on best practices.
3. Focus on perioperative management: Understand the risk factors for patients and address these issues prior to surgery. Individualized risk assessments based on age, current medications, family history and other risk factors can help the physician better understand the patient while adhering to strict, evidence-based guidelines.

Curbing blood use practices can be a big culture shift. Whether looking at blood use overall or pinpointing specific procedures that account for significant blood use, providers can drive real, evidence-based change across services lines with the right data, stakeholders and preventative care for the benefit of patients.

For more information, download Premier’s Margin of Excellence report on Blood Utilization.