Now more than ever, healthcare providers face constant pressures to simultaneously improve quality and reduce costs.
To accomplish these twin goals, many are using data to identify unjustified and expensive variation in care delivery. One case study in harnessing data to spotlight performance opportunities is with blood usage.
Blood transfusions are a dual-edged sword. A transfusion can save a patient’s life, but unnecessary use can increase the odds for adverse events, such as allergic reactions, fever, lung injury, immune suppression, iron overload and more. Transfusions have also been linked to an increased risk of morbidity and mortality. One study found blood transfusions were associated with a 66 percent increased risk of mortality when accounting for comorbidities and other factors during cardiac surgery. And misuse of this commodity has significant financial implications – blood transfusions can cost upwards of $1,000 per unit when accounting for all direct and indirect costs.
Given the research, providers are increasingly taking action to optimize use of blood and blood products by leveraging benchmark data and enacting best practices. In an analysis tapping inpatient data on more than 27 million discharges across 645 hospitals, Premier found a 20 percent decrease in blood utilization across 134 diagnoses that account for 80 percent of red blood cell use. Additionally, the analysis found that blood use was cut nearly in half across the 10 procedures that account for the most transfusions. And 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.
Cincinnati-based Mercy Health is a good case in point. By understanding the state of blood use within the hospital through data and implementing evidence-based practices, the health systems realized $6.2 million in savings as a result of conserving red blood cell, platelet, plasma and cryo use across both inpatient and outpatient facilities over a three-year period.
While research suggests that providers are growing savvier in managing blood resources, there is still work to be done. Despite nationwide improvements in blood use, protocols and practices continue to vary significantly across hospitals and departments, and estimates suggest that approximately 40 percent of the blood and blood products used may be unnecessary. In fact, any two patients receiving the same surgery may or may not receive a transfusion depending on a provider’s culture around blood use— which can compromise quality of care.
Based on our work with providers to create more efficient, data-driven blood management programs, Premier has developed best practices and baseline requirements for success in optimizing blood use. While no two patient blood management programs are alike, hospitals and health systems are able to tailor programs to achieve the best results in curbing unnecessary blood use.
• Data is king: Using data and benchmarks, leaders gain a better understanding of internal trends and how their performance stacks up against peers. This intelligence provides the opportunity to target variation in blood use and reign in ineffective practices at the service line, procedure or even physician level. Data is also critical to monitor progress and facilitate the feedback loop for clinicians to make patient blood management programs work. Working with Premier, BayCare gained access to critical performance benchmarks for peer comparisons to get their patient blood management off the ground. Since their efforts began, BayCare has seen a 54 percent decrease in red blood cell use, which amounts to more than 58,000 units saved.
• Education is effective: Longstanding habits and lack of information on alternatives to blood transfusions can be tackled with targeted physician education efforts. Holding rounds with relevant departments, garnering feedback on guideline development and dissemination and real-time feedback and practice reviews are all strategies that can be used. Clinical decision supports can educate physicians ordering blood via real-time alerts if an order doesn’t follow evidence-based guidelines. At Carle Foundation Hospital, the team used computerized alerts to remind physicians of guidelines in place for proper blood use. With consistent feedback and reminders, the culture shift has taken shape – helping them decrease the number of blood transfusions by 35 percent and generate a savings of $2 million over the course of two years
• Perioperative management is prime: Anemia is a treatable condition that can be addressed prior to surgery without a transfusion. Understanding risk factors and addressing these underlying issues before patients reach the operating room can reduce the need for transfusions. Encouraging preoperative risk assessments to ensure optimal recovery for patients going into procedures associated with a high volume of blood use can help physicians identify risk factors that can be addressed prior to surgery and avoid the transfusions. As part of the Perioperative Surgical Home Collaborative, a team including surgeons and anestheologists at White River Medical Center holistically looked to optimize blood utilization during orthopedic surgeries. This included treating preoperative anemia, use of transexamic acid to stem blood loss and lowering of transfusion thresholds. Since the program has been implemented, the transfusion rate has been reduced by more than 50 percent.
Managing blood use can be a challenge without strong data and analytics to measure total utilization rates, compare against peer benchmarks and spot areas for improvement. In our work with providers, we’ve learned that effective blood stewardship programs are born from using data and measurement to pinpoint opportunity areas and implement evidence-based practices.
Leigh Anderson is chief information officer and Robin Czajka, RN, is service line vice president, cost management at Premier Inc.
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