But we have a long way to go to bring the rate of transfusion to a level supported by evidence-based medicine. At 44 units per 1,000 population, the transfusion rate in the U.S. remains higher per capita than in other Western nations. The rate in Canada, for example, is about 30 per 1,000, without any significant differences in outcomes.
In a 2013 report from the National Summit on Overuse, the Joint Commission and the American Medical Association describe an effective PBM program as one that includes education of clinicians; dissemination of evidence-based best practices and guidelines; availability of expert guidance; scheduled assessments of prescriber transfusion practices; and standardization of performance metrics, data collection and vocabulary to validate benchmarking within organizations.
The performance of Northern California hospitals served by our not-for-profit blood center exemplifies the progress that can be made when such a program is in place. The result is an average number of units transfused being 31 per 1,000, about 30% fewer than the national average.
Excellent trials and guidelines are available to influence transfusion decisions, and the Joint Commission/AMA Summit report concludes that, to promote the appropriate use of blood, changing behaviors is the best solution.
It's time for all hospitals to address the inappropriate use of blood transfusion, the risk it poses to patients and the unnecessary costs for providers. Behaviors contributing to misuse can be modified, and PBM has proved to be a powerful agent for that change.
Wendy Knowles is transfusion safety officer for BloodSource, a not-for-profit supplier of blood products and services based in Mather, Calif. It serves more than 40 hospitals in 25 California counties.