The Greater New York Hospital Association, which has been sending out a clarion call about an impending blood crisis for months, was underwhelmed to learn last week that HHS is launching a daily monitoring network to track the blood situation at hospitals in key areas of the country.
"Hospitals know immediately when there is a shortage," said Kenneth Raske, the trade association's president. "All they have to do is open the refrigerator and see how many units there are."
HHS officials agree but say blood availability is more than a supply-side problem. The "sentinel system" the government is establishing is described as a research study in progress that will gather daily reports from 29 selected hospitals throughout the country. Besides daily inventories, the sentinel hospitals-four of which are in New York City-will feed the network information about how much blood they transfused and what, if any, efforts they took to replenish dangerously low supplies.
Ultimately, HHS hopes the monitoring system will quickly identify a strategy for giving hospitals and blood banks early warnings of potential problems, said Stephen Nightingale, M.D., an executive in the office of public health and science at HHS. But with a limited budget and such a small sampling of the nation's 5,000 hospitals participating, a warning bell from one sentinel hospital may in the end be just a warning bell for that hospital, he added. Or it could be more than that, signaling a regional problem.
"We know what the supply is, but what we don't know is if the supply is sufficient to meet the demand," Nightingale said. "If you ever took a basic economics class, you learned to monitor price to measure demand, but that doesn't work well for blood."
The system comes at a time when blood economics are running as erratically as the stock market. As new screening tests are developed, prices to cover the costs have escalated. The American Red Cross, which supplies half of the nation's hospitals, raised prices by an average 31% earlier this summer to catch up with 10 years of underpricing (May 21, p. 8).
Meanwhile, New York hospitals in particular are steeling for a 33% drop in supplies as a result of new restrictions on donations that are expected to be implemented by the American Red Cross in September and the Food and Drug Administration sometime next year. Deferring donations from people who have lived or traveled in European countries over concerns about the potential transmission of mad cow disease will reduce the nation's blood supply by an estimated 8%. In addition, hospitals in the New York region import about 25% of their blood supplies directly from Europe, according to the GNYHA.
That impending crisis was assuaged somewhat last week when the nation's two major blood suppliers, the American Red Cross and America's Blood Centers, committed to providing the New York City region with thousands of additional units of blood.
That's only the supply-side problem. Demand is rising, too. Where once availability was predictably low around holiday times, now increased demand results in alarming shortages even during the traditionally optimum periods of April and October, said Melissa McMillan, a spokeswoman for America's Blood Centers, Washington, whose 75 independent members collect the other half of the nation's blood supply. Sophisticated cancer treatments and transplant surgeries are driving much of the demand, even though blood centers are doing their job of recruiting blood donors, she added.
Donors gave 13.9 million units of whole blood in 1999, according to the National Blood Data Resource Center, an independent not-for-profit organization based in Bethesda, Md. Blood centers collected 93% of the total, while hospitals collected 7%. Meanwhile, U.S. hospitals transfused 12.4 million units of whole blood and red blood cells to 4.5 million patients, an 8% increase over the 11.5 million units transfused in 1997.
"It's a great system," McMillan said about the HHS plan. "We're excited about it.
Harold Kaplan, M.D., director of transfusion medicine at Columbia Presbyterian Medical Center, New York, one of the sentinel hospitals, said it hasn't yet reached a point where surgeries are being delayed because of blood shortages.
"This is an opportunity to practice the preventive medicine we talk about," Kaplan said. "It will help in heading off issues that could get much worse. We're not right now experiencing a crisis, and we would like not to experience one."
The government tracking system, which will cost approximately $350,000 per year to implement, will be developed over the coming weeks, HHS officials said. Ultimately, the agency plans to offer the information on a public Web site.
Contracts with the hospitals are being signed. Besides New York, the 29 hospitals that will feed the system are in Atlanta; Bismarck, N.D.; Boston; Chicago; Dallas; Denver; Indianapolis; Iowa City, Iowa; Los Angeles; Miami; Minneapolis; Mobile, Ala.; New Orleans; Pittsburgh; Seattle; Tampa-St. Petersburg, Fla.; Tucson, Ariz.; and Washington.
Nightingale said the hospitals were recruited based on geography and their willingness to participate. Requests went out to 33 hospitals, and 29 responded, he said. Bearing the full cost of the project, HHS is paying each sentinel hospital about $5,000 under six-month contracts, he said.