Premier Health Rolls Out Comprehensive Patient Blood Management Program

By Barbara Steel, MD, system physician lead, Patient Blood Management

In January 2018, Premier Health initiated a system-wide Patient Blood Management program. Patient Blood Management (PBM) has been defined as an evidence-based, comprehensive approach to optimizing the care of patients who might need transfusion. Blood management has become an important value initiative in health care over the past 10 years.

Blood transfusions are one of the top five overused medical therapies, according to the American Board of Internal Medicine Choosing Wisely campaign. Transfusions also present significant risk, as they have been associated with hospital acquired and transfusion transmitted infection; transfusion-related immune modulation; alloimmunization; and allergic reactions. Transfusion-associated circulatory overload and acute lung injury are the leading cause of transfusion-related mortality.

With more than 32,000 blood transfusions occurring each year at Premier Health, reducing unnecessary transfusions represents an important patient safety initiative. Transfusions are costly. While the typical acquisition cost of a RBC unit is more than $220, the actual administrative, technical, and clinical cost to the system is estimated to be several times higher. Hospital systems that have successfully implemented a PBM program have realized significant improvement in medical and surgical outcomes, as well as cost savings.

PBM has three goals: optimize red blood cell mass and hemostasis, minimize blood loss, and improve the patient’s tolerance to anemia. Our program will initially focus on updating our transfusion guidelines. Integration of these guidelines into a simplified, computer order entry will assist clinicians in the decision-making process. Departmental performance improvement will be greatly facilitated by a data analytics transfusion dashboard that will track and compare clinicians’ transfusion practices over time. Hospital, department, and provider-specific transfusion data can be compared within Premier Health and against national standards. Oppotunities for further clinical training in optimal blood management will be offered through educational awareness campaigns and expert guest speakers.

Strategies to minimize anemia by preventing blood loss and maximizing a patient’s own blood mass are an integral component of PBM. The risk of transfusion steadily increases as anemia worsens. Anemia is common, often affecting 20 percent or more of preoperative patients. Moreover, it is an independent predictor of poor outcomes. Musallam et al (Lancet 2011) evaluated 227,425 preoperative patients in the NSQIP database, and demonstrated that preoperative anemia significantly increased the risk of mortality across a broad array of surgical interventions. Anemia programs will focus on the identification and management of iron deficiency anemia across the full continuum of care. Important contributors to anemia and poor outcomes are iatrogenic blood loss and hospital acquired anemia. The judicious use of coagulation algorithms, global hemostasis techniques such as TEG, blood salvage, and minimizing phlebotomy will help to ameliorate this problem.

To best position this initiative for success, Premier Health entered into a five-year engagement with Accumen in January 2018. This national company has a proven track record in patient blood management and laboratory optimization in more than 200 hospitals across the country. Their expert guidance will allow Premier Health to establish a quality PBM program. 

Back to the May 2018 issue of Premier Pulse