Looking at transfusion a different way

In 2016, in an effort to improve patient outcomes and properly utilize donations, Parkview collaborated with Accumen, a consulting partner, to improve patient blood management (PBM) processes within the health system. Julia Crosby, MT (ASCP), BB, Parkview Health Blood Bank specialist, and Lisa Daniel, director, Corporate Lab Services, explain what these changes mean to patients.

A new process

We partnered with Accumen to develop the PBM parameters and program. They helped jumpstart our program by providing experts to educate physicians, advanced practice providers (APPs) and nurses about blood management and why it is important.

With the old process, we pursued transfusions based on the patient’s hemoglobin number. For example, if the hemoglobin was above 8g/dL-, we would not transfuse, and if it was below 8, we would transfuse.

Recent studies indicate that there are many negative impacts of transfusion, including a down regulation of the patient's immune system. Patients receiving transfusions tend to have longer length of stay and more complications than patients who are not transfused, with the same diagnosis. We know that each patient's ability to make their own blood varies, and we also know that some patient's symptoms of anemia do not show up at the same Hgb as others. So, in the absence of symptoms we are more likely to allow patients to "make their own blood", and not transfuse unless their hemoglobin falls below 7 g/dL, sometimes even a bit lower. 

Recent studies also indicate the same or better outcomes for patients who are transfused with the more restrictive guidelines (hemoglobins less than 7 g/dL) than those who are transfused more liberally. In addition, there’s a per-unit cost to the patient for transfusion. By restricting unnecessary transfusion, we save the patient money, provide better care and avoid negative consequences. 

We have developed other methods to limit anemia and bleeding, such as surgical cell-salvage, limiting blood loss from lab testing, pharmacological reversal of bleeding, and anemia management and recognition protocols.

The results

Within our system we have seen a 24 percent decrease in blood product use per year since 2016, when the project started. We are still developing metrics for factors that we can measure, such as decreased length of stay. We have not had any reports of negative patient outcomes based on the more restrictive transfusion practices. 

The takeaways

Our approach to transfusion is patient-centered rather than transfusing to a number. We are mindful that the best blood for a patient is their own blood, and we make efforts to only transfuse when absolutely necessary, employing other interventions whenever possible. 

PBM helps us to ensure that the blood we have is used judiciously. Our blood suppliers struggle to provide the products we need on a daily basis and we experience frequent shortages. By doing our part to decrease unnecessary transfusion, we help our blood suppliers to ensure blood is available to all patients when really needed. 

Want to learn more about blood donation? Visit redcrossblood.org.

 

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