Photo by Juan D. Alfonso
CHICAGO—Researchers say an electronic tracking system has enabled a group of hospitals to significantly reduce the amount of blood transfused after operations.
This system also cut costs by an estimated $2.5 million over 2 years and contributed to lower infection rates without harming patients.
These results were presented at the 2015 Clinical Congress of the American College of Surgeons and published in the Journal of the American College of Surgeons.
In 2012, Intermountain Healthcare implemented the blood ordering and tracking system, along with a program to educate hospital staff, in 22 hospitals across Utah. This includes trauma centers, small rural hospitals, and large community medical centers.
Intermountain employs approximately 1200 physicians and 550 advanced practice clinicians, and another 3000 to 4000 independent physicians have privileges at Intermountain hospitals.
Before Intermountain implemented its blood tracking system, general surgeons, orthopedic surgeons, and urologists each used different hematocrit levels to order blood.
Now, Intermountain uses a consistent threshold across all disciplines—less than 23%. However, physicians can still order blood for patients with hematocrit above that threshold when they feel it is medically necessary.
Results
In 2011, 6% of all patients at Intermountain facilities received blood. Today, only 4% do, according to study author Mark J. Ott, MD, chief medical director of Intermountain Healthcare’s central region.
“So a third of our patients didn’t get blood who used to,” Dr Ott said. “That’s a giant change. That’s tens of thousands of units of blood a year that didn’t get used.”
Before the program started (January 1, 2012), Intermountain facilities transfused almost 50 units of packed red blood cells per 1000 patient days. By January 31, 2015, that rate had declined to about 35.5 units, a reduction of around 30%.
Over the same time period, the percentage of patients transfused with a hematocrit of 23% or greater decreased from 60% to 34%.
The researchers said these reductions in blood use reduced costs by about $2.5 million over the 2-year period, assuming each unit of packed red blood cells costs $300.
In addition, the rate of hospital-acquired infections for both the general hospital population and patients who received blood declined significantly over the 2-year period.
The overall infection rate fell from 1.66 to 0.81 per 1000 patient days. Among patients who received blood, infection rates declined around 33%.
Dr Ott noted that the reduction in infections was also impacted by other initiatives within the health system aimed at reducing surgical site infections and ambulating patients earlier after operations.
“So I cannot tell you that those decreases in hospital-acquired infections are solely due to patients receiving less blood, but it’s part of the picture,” he said. “And we did not see worse outcomes in patients.”
