Any volunteer donor who has paid attention to employees at a blood bank can attest to the care and caution exercised in handling and storing blood. It may come as a surprise, then, to know that an excessive amount of blood goes to waste in medical facilities each year.
Blood waste can occur for a number of reasons, from improper storage and handling to time expiry, blood ordered and not used, stock time expired and the rupturing of red blood cells to name a few.
The misuse and waste of blood adds up quickly. Factoring both indirect and direct costs, a unit of blood (roughly a pint) can cost as much as $1,000. As you might expect, blood becoming unusable sends costs soaring.
Big Data, however, might be the key to reversing blood waste.
A program developed and run by Premier Inc., a healthcare improvement alliance of 3,000 hospitals and more than 100,000 providers, has shown the ability to significantly decrease blood utilization.
Premier analyzed data from 645 facilities in 45 states, accounting for more than 27 million inpatient discharges between 2011 and June 2016.
Using cost and quality data analytics, Premier generated optimization reports to help providers spot cost and quality changes in blood use, as well as pinpoint the individuals or departments contributing to the issue. These reports have helped Premier’s clients dramatically reduce overall blood use.
The data analytics initiative yielded the following as well:
- For the 10 procedures that use the most blood, blood use was cut in half.
- Orthopedic procedures showed steep decline with almost 75% fewer cases recording a blood transfusion.
- No compromise in quality of care. In fact, rates of mortality, complications and readmissions dropped.
A study at Vanderbilt University Medical Center in Nashville had similar results according to an article from Science Daily.
Beginning in 2011, the study tracked the effects of using evidence-based guidelines for blood transfusion. Among the findings: blood utilization was cut by more than 30%, from 675 units per 1,000 discharges in 2011 to 432 units per 1,000 discharges in 2015, saving the facility $2 million over three years.
To lower blood waste, doctors instituted a series of measures, starting with a change to 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 rather than requiring the doctor to specify the number. The results were striking, as waste dropped from 300 units in 2011 to fewer than 80 in 2015.
Unnecessary transfusions were also targeted as they can be both expensive and dangerous for the patient. According to an article from Healthcare Informatics, an unnecessary transfusion can “diminish quality of care, increasing the likelihood of allergic reactions, fever, lung injury, immune suppression, iron overload and other adverse events.”
The study’s success was contingent on the medical professionals involved being willing to challenge the way things had always been done.
When Dr. Louis Katz, now chief medical officer of the national blood bank network America’s Blood Centers was a medical student, he learned blood transfusion standards that were unquestioned.
“That’s what I was taught. It wasn’t based on evidence. It was based on, ‘Here’s how we do things,’” Katz told Modern Healthcare. “We did what we were told by the people who taught us.”
Educating medical staff and developing a best practice advisory program were also important elements to the effort. The most dramatic reductions occurred around transfusions in orthopedic surgical procedures, which decreased nearly 75% during major joint replacement surgeries. Almost 30% fewer hip and femur surgery patients received transfusions, as well.
As noted in an article from Health IT Analytics, the research shows that a combination of “clinical decision support, enhanced care quality guidelines and the use of Big Data analytics to monitor cost and quality can significantly reduce blood waste.”