Time to transfuse best blood practices at hospitals

The nation's hospitals are rapidly adopting evidence-based patient blood-management practices, and for good reason: preventing inappropriate transfusion improves care and reduces costs.

In 2011, 30% of hospitals reported having PBM programs and another 15% have adopted some PBM practices, according to an HHS survey. The survey report credits PBM for an 8.2% reduction in transfusions since 2009, with 1.2 million fewer units of whole blood/red blood cells transfused and 60,000 fewer transfusion-related adverse events. This translates into improved outcomes, and with an average cost of $225 per unit of blood, considerable savings for hospitals, not counting the blood administration costs or those associated with treatment of transfusion-related adverse events or increased length of stay.

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.