Eastern Maine's program uses multiple levers to encourage appropriate use of transfusion, including ongoing physician education and alerts embedded in the computerized physician-order entry system. For instance, if a physician orders a unit of blood for a patient whose hemoglobin levels are outside the hospital's usual thresholds, an alert is triggered. The CPOE system also made it more difficult for physicians to order more than one unit of blood at a time, a common practice that Gross says contributes greatly to overuse.
“CPOE alone won't change practice, but it's a tool that can reinforce and hardwire the principles of blood management,” he said.
Gross and his team also created a transfusion report card so physicians can see how they compared to their colleagues, a step that helped drive down unneeded clinical variation.
In the years since the program began, the number of red blood cell transfusions at Eastern Maine plummeted nearly 60%. Use of platelets and plasma fell 50% and 75%, respectively. And those reductions came with no significant change in clinical services, Gross said.
The percentage of preferred single-unit orders grew from 55% to almost 90%, and the hospital's target hemoglobin level for transfusion fell from 8.5 to 7.8. The hospital also has seen improvements in lengths of stay that Gross says are attributable to the program.
On the financial side, blood acquisition costs have fallen by $1.6 million annually. For cardiac surgery alone, costs per case have dropped 10%.
Dr. Mark Brown, chief of pediatrics and head of newborn medicine at Eastern Maine, said the blood management program has had a transformative effect on blood usage and patient outcomes. He is working with Gross to develop a version for the neonatal intensive-care unit. “I'm constantly surprised that more hospitals aren't doing this,” Gross said. “It fulfills all three corners of the Triple Aim triangle.”
Follow Maureen McKinney on Twitter: @MHMMcKinney