Patient Blood Management Successes and Goals

By Jennifer Hauler, DO, system chief medical officer, Premier Health

I want to extend my sincerest gratitude to the hospital leadership teams and providers across Premier Health for supporting the system-wide, comprehensive Patient Blood Management (cPBM) initiative in 2018. Because of you, Premier Health made a significant impact in saving blood and saving lives!

Over the past 10 months, Accumen and our hospital physicians, providers, and partners have worked diligently to implement evidenced-based strategies aimed at reducing unnecessary and avoidable transfusions to improve patient safety and stewardship. The steering committee updated transfusion guidelines, shared meaningful transfusion analytics to drive change, embarked on a comprehensive education and awareness campaign, established a system-level multidisciplinary cPBM committee, and completed CPOE design for transfusion order sets. As a result, we have accomplished the following in 2018:

• Decreased more than 2,200 unnecessary and/or avoidable transfused units
• Avoided 30 potential transfusion-related complications and decreased length of stay by 1,104 days
• Estimated seven lives saved from avoided transfusions
• Saved $482,000 in blood acquisition costs and an estimated $1.5 million to $2.3 million in associated transfusion costs (testing, processing, supplies, labor) – not including the cost of transfusion-related adverse events
• Met or exceeded two out of three PBM metric goals:
  • Increase percentage of RBC transfusions for a Hgb <7.0 g/dl to greater than 60 percent by end of fiscal year 2018
    • Actual as of 10/31/18: 62 percent (a 35 percent increase!)
  • Decrease percentage of RBC transfusions for a Hgb ≥8.0 g/dl to less than 11 percent by end of fiscal year 2018
    • Actual as of 10/31/18: 11 percent (a 31 percent reduction!)
  • Increase percentage of RBC transfusions ordered as SINGLE units to greater than 65 percent by end of fiscal year 2018
    • Actual as of 10/31/18: 62 percent (a 17 percent increase!)

While our efforts and successes are to be commended, there is still opportunity for further improvement. Therefore, Premier Health must remain sincerely committed to our cPBM initiatives and press on toward continuously advancing our quality of care. In 2019, we will continue to raise the bar on quality and safety with new metric goals as we make the journey toward best in class. Our 2019 goals:

• Increase percentage of RBC transfusions for a Hgb <7.0 g/dl to greater than 67 percent by end of fiscal year 2019
• Decrease percentage of RBC transfusions for a Hgb ≥8.0 g/dl to less than 8 percent by end of fiscal year 2019
• Increase percentage of RBC transfusions ordered as SINGLE units to greater than 76 percent by end of fiscal year 2019

In the following months, the team will dig deeper into effective cPBM strategies aimed at optimizing anemia management, platelet and plasma utilization, and minimizing bleeding and blood loss. Drs. Steel and Kramer and the Accumen team will continue reaching out to engage you in discussions regarding current practice and evidence-based clinical strategy recommendations. I hope you will give this your full attention and support.

Premier Health remains committed to this initiative, emphasizing that our priority is to improve patient safety and clinical outcomes. This initiative will require active participation from many different departments and specialties throughout the hospitals, and support from leadership, medical staff, nursing, pharmacy, and laboratory personnel. We cannot do it without each of you!

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