BUILDING AND SUSTAINING A BLOOD MANAGEMENT PROGRAM

Transcription

1 SHERIDAN LEADERSHIP BRIEF BUILDING AND SUSTAINING A BLOOD MANAGEMENT PROGRAM How Creating and Implementing Standards for Transfusions Resulted in Better Clinical Outcomes and Cost Savings for Hospitals ANESTHESIOLOGY EMERGENCY NEONATOLOGY S H E R I D A N H E A LT H C A R E. C O M RADIOLOGY

2 ANESTHESIOLOGY EMERGENCY NEONATOLOGY INTRODUCTION BLOOD TRANSFUSIONS ARE AMONG THE MOST COMMON MEDICAL PROCEDURES at U.S. hospitals. 1 But when it comes to this lifesaving treatment, more is not always better. Transfusions come with a higher risk of mortality and other dangerous complications. Transfusions are costly for hospitals. In a 2010 study published by Transfusion, a peer-reviewed academic journal, it was estimated that blood transfusion costs range costing between $1.6 to $6.0 MILLION per hospital surveyed. from $522 to $1,183 per unit. 2,3 The study also confirmed that blood transfusion-related costs for surgical patients are a significant resource drain - costing between $1.6 to $6.0 million per hospital surveyed. 3 Transfusions are managed differently from hospital to hospital. Even today, with more than 15 million units of blood transfused per year in the United States, the practice is not by any means a standardized process. 2 RADIOLOGY Healthcare reform, reduced funds, rising blood costs, and the desire for better clinical outcomes have exposed the need for effective blood management. A growing number of hospitals are instituting blood management programs, which are guidelines as to when a transfusion is necessary or avoidable. A few forward-thinking hospitals prompted by their physician partners who take the initiative are spearheading the efforts, studying the impact, and developing the protocols. This paper explains the need for blood management programs and how they can be implemented at hospitals to save money and produce positive patient outcomes SHERIDANHEALTHCARE.COM

3 LEADERSHIP DRIVES PERFORMANCE PAGE 2 THE NEED FOR BLOOD MANAGEMENT PROGRAMS ACCORDING TO THE JOINT COMMISSION S STUDY on appropriate blood management, 4 the following issues in patient blood performance measures (PBM) were noted: Inconsistent Protocols Informed consent for blood transfusions is not required by all states, and the consent process varies between hospitals Hospitals have different acceptable pre-transfusion lab values Lack of national guidelines causes inconsistent use of transfusions It s difficult to identify transfusions during surgery Point-of-care testing is not used in all hospitals during surgery Transfusion orders are usually not required or documented during surgery Lack of Standardized Lexicon Difficult to determine if documentation of clinical indication is sufficient No standardized definition is used for bleeding The order to transfuse is sometimes confused with the order to type and cross-match in surgery Inconsistent Education Information about transfusion is not consistently given to patients Information is provided by a variety of staff Staff needs education about the risks, benefits and alternatives

4 THE MANY COSTS OF BLOOD Direct: The average acquisition cost for one unit of red cells is $ Activity-Based: U.S. range is $ to $1, Indirect: Issuing and Delivering Testing Administration and Monitoring Inventory Management & Storage Transfusions also affect: Length of stay Infection rates Complication rates Mortality Legal TRANSFUSION PRACTICES VARY GREATLY A STUDY DONE BY THE INSTITUTE OF MEDICINE (IOM) SUGGESTS THAT THERE IS WIDE VARIABILITY IN WHEN BLOOD TRANSFUSIONS ARE PERFORMED. This is partly because the decision to transfuse is largely affected by non-clinical factors in most cases. The evidence led the IOM to believe that transfusions in many hospitals may seem necessary, but are in fact inappropriate. 7, SHERIDANHEALTHCARE.COM

5 LEADERSHIP DRIVES PERFORMANCE PAGE 4 THE CREATION OF BLOOD MANAGEMENT PROGRAMS of all improvement initiatives within hospitals and health systems are either wholly or partially dependent on doctors making them happen. This was the case for anesthesiologist Robert Brooker, M.D., who championed a blood management program at Memorial Healthcare in Hollywood, Fla. THE TENETS 9 OF THIS PROGRAMS ARE: Work with cardiologists before surgery to make sure the patient is not on unnecessary doses of blood thinners, which promote bleeding, and to ensure an anemic patient has proper pre-op medicine Draw a unit of blood from the patient the day of surgery, in case it is needed Reduce the amount of plumbing in the heart/lung machine, keeping the patient s organs functioning during surgery so that it uses less blood-diluting fluids Carefully ration IV fluids during surgery so the patient s blood concentration does not drop unnecessarily Preserve and store red blood cells from blood that s lost during surgery, using a suction device called a cell saver Standardize the way anti-bleeding medications are given during surgery Standardize what constitutes the transfusion threshold, or how far blood levels can drop before triggering a decision to give the patient a transfusion

6 CASE STUDY MEMORIAL REGIONAL HOSPITAL (HOLLYWOOD, FLA.) THE ADMINISTRATION AT MEMORIAL REGIONAL HOSPITAL in Florida had the goal to develop a top-notch cardiac surgery program, an element of which was to make open heart surgery safer. Sheridan anesthesiologist Dr. Robert Brooker, the hospital s chief of cardiac anesthesia, initiated a blood conservation program to improve its transfusion rates. Cardiac surgery programs are under increasing scrutiny to provide the highest quality of care, and the rate of transfusions is an important measurement of quality of care, Dr. Brooker. 10 Blood transfusions in heart surgery, or anywhere, are only good for you if you really need it, Dr. Brooker 9 Blood transfusions in heart surgery, or anywhere, are only good for you if you really need it. It s like a liquid organ transplant. If you don t absolutely need to have it to save your life, you shouldn t get it. Dr. Brooker. 9 IN 2008, THE HOSPITAL STARTED FOLLOWING AN ESTABLISHED PROTOCOL and conducted a five-year study of the results of more than 1,000 patients. Dr. Brooker presented the findings at the 2013 American Society of Anesthesiologists annual meeting % reduction in cardiac patients needing surgical transfusions, from 59% to 19% 80% decrease in the amount of blood needed, from 1.7 units to.33 units, saving $ per unit 50% drop in heart surgery-related deaths, infections, strokes and re-operations 100% decrease in infections, falling from 3.2% to 0% SHERIDANHEALTHCARE.COM

7 LEADERSHIP DRIVES PERFORMANCE PAGE 6 PHYSICIAN CHAMPIONS CHANGE HOSPITALS FOR THE BETTER THE BLOOD MANAGEMENT PROGRAMS AT SEVERAL HOSPITALS, including the one outlined in this paper, were instituted and championed by Sheridan physicians who believe that leadership drives performance through integrity, excellence, creativity, teamwork and respect. Physician leaders at a hospital can greatly impact whether change happens or not and whether change is successful or not. Sheridan physicians embody the necessary dedication to collaborative leadership and hospital alignment needed in today s hospital environment. To learn more about the processes behind various hospital initiatives and success stories, visit Sheridan s Resource Center online ( for case studies, leadership briefs, and research and white papers. To discuss how our performance-driven solutions can help increase efficiency and communication in your hospital, contact us at THOUGHTLEADERSHIP@SHCR.COM or REFERENCES: 1. Pfuntner, A., Wier, L. & Stocks, C. Most Frequent Procedures Performed in U.S. Hospitals, Healthcare Cost and Utilization Project. February, Retrieved from 2. Frellick, M. Better blood management could be a boon for hospitals. Hospitals & Health Networks. September 1, Retrieved from HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Magazine/2012/Sep/0912HHN_FEA_Trending 3. New Published Study Finds the Cost of Blood Transfusions is Significantly Under-Estimated, Establishes True Cost at $522 to $1,183 Per Unit. PR Newswire. April 5, Retrieved from 4. Rhamy, J. Accreditation Organizations Role in Reducing Overuse: Appropriate Blood Management Example. The Joint Commission Accreditation Laboratory Valenti, J. Cost Savings and Patient Blood Management. Society for the Advancement of Blood Management Annual Meeting Retrieved from org/sites/ 6. Administrative and Clinical Standards For Patient Blood Management Programs The Society For the Advancement of Blood Management. Retrieved from sabm.org/sites/sabm.org/files/second-edition-draft-of-administrative-and-clinical-standards-for-patient-blood-management-programs.pdf 7. Shander A, Goodnough LT. Blood transfusion as a quality indicator in cardiac surgery. JAMA; 304: Shander A., et al. From Bloodless Surgery to Patient Blood Management. PBM Review Brochu, N. Memorial Regional s blood conservation efforts a success, hospital officials say. Sun-Sentinel. November 8, Retrieved from com/ /health/fl-blood-transfusion-conservation _1_valve-surgery-transfusion-open-heart-surgery 10. Sheridan Healthcare Anesthesiologist to Present at ASA Annual Meeting. Business Wire. October 1, Retrieved from home/ /en/sheridan-healthcare-anesthesiologist-present-asa-annual-meeting#.vrrfmpnf_ye

8 About Sheridan Healthcare SHERIDAN IS ONE OF THE LEADING PROVIDERS OF HEALTHCARE SOLUTIONS FOR ANESTHESIOLOGY AND OTHER SPECIALTIES to physicians, hospitals and outpatient centers. Physician led and managed, Sheridan provides comprehensive clinical and management solutions for anesthesia outsourcing and other specialty areas including emergency medicine, neonatology and radiology. Our dedication to collaboration, leadership and quality provides our hospitals and patients with the care they deserve SHERIDANHEALTHCARE.COM ANESTHESIOLOGY EMERGENCY NEONATOLOGY RADIOLOGY OUTSOURCED CLINICAL & MANAGEMENT SERVICES