Blood Utilization Guidelines Save Millions of Dollars

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After implementing institutional initiatives to address blood management, a multidisciplinary team at Vanderbilt University Medical Center in Nashville, Tenn., improved the processes of ordering, transporting and storing blood, according to an article from News Medical, an online medical information provider.

A team of administrative and executive leaders, physicians and nurses at the academic medical center implemented blood utilization practice guidelines that resulted in $2 million in savings and a 30% reduction in blood utilization, as noted by a poster presentation at the 2016 American College of Surgeons National Surgical Quality Improvement Program Conference in San Diego.

“The transfusion committee at Vanderbilt was interested in evaluating how we could implement evidence-based guidelines around restrictive transfusion,” according to lead study author Barbara J. Martin, MBA, RN.

The first step to address blood management involved transitioning from the previous standard process of initially ordering two units of blood for transfusions to ordering a single unit and then ordering more if necessary.

“The data on restrictive transfusion has been out for years documenting that patients have better outcomes with a more restrictive transfusion strategy. 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,” Ms. Martin said.

Vanderbilt was able to reduce red blood cell transfusions from 675 units per 1,000 discharges in 2011 to 432 units per 1,000 discharges in 2015.

The team also investigated how to reduce blood wastage, creating guidelines for perioperative handling. As noted by the article, guidelines include:

  • When more than one unit of blood is ordered it is sent in a cooler rather than the pneumatic tube.
  • Coolers were reconfigured to optimize temperature management.
  • A specific member of the staff is tasked with “ownership” of the blood products, including returning unused product to the blood bank.
  • Individual unit wastage is reported to clinical leaders for review; aggregate data are reported monthly.

The improvements in blood utilization at Vanderbilt resulted in fewer than 80 units of blood wasted in 2015, reduced from 300 in 2011.

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