In retrospect, the problem—and a feasible solution to it—seemed obvious. If blood was brought to the operating room and then stored unused at the wrong temperature, it would have to be thrown out.
“It happened pretty often,” recalled Barbara Martin, a registered nurse at Vanderbilt University Medical Center in Nashville who led a recent study on blood utilization and wastage that found systemic changes could successfully curb both.
The study, which began in 2012, examined the effect of implementing evidence-based guidelines for blood transfusion. Those changes cut blood utilization by more than 30%, researchers found, dropping it from 675 units per 1,000 discharges in 2011 to 432 units per 1,000 discharges last year. They also found the changes yielded $2 million in savings over three years.
The study also looked to stem blood wastage, putting in place a series of measures that ultimately helped bring waste down from 300 units in 2011 to fewer than 80 in 2015.
At the heart of the three-year study was a willingness to challenge protocols in place simply because that's the way things had always been done. But such processes are slowly evolving, driven in part by studies like Vanderbilt's that demonstrate the benefits of new, evidence-based practices.
When Dr. Louis Katz, who was not involved in the Vanderbilt study, trained as a doctor decades ago, he was taught unquestioned standards about blood transfusion. The appropriate threshold for hemoglobin was around 10 grams per deciliter, he learned, and doctors should always give two units of blood, never one.
“That's what I was taught. It wasn't based on evidence. It was based on, 'Here's how we do things,' ” said Katz, chief medical officer of the national blood bank network America's Blood Centers. “So we did what we were told by the people who taught us.”
As part of the study at Vanderbilt, Martin and her colleagues changed the default settings in the computerized provider order entry system. When doctors ordered blood for anemic patients, the order would be for a single unit of blood rather than requiring the doctor to specify the number of units needed.