Putting Patients First

Achieving better outcomes with blood management

Recently, Kara Fortune, PharmD, Director of Pharmacy Solutions and Member Support, and Becky O’Neal, MBA, MLS, Director of Lab Solutions, joined Drew Preslar, MBA, AVP of Advisory Services, on HealthTrust’s Candid Conversations podcast to discuss the benefits and challenges of patient blood management programs. A summary of the discussion follows.

At its core, a patient blood management program promotes the optimal use of blood products throughout the hospital, using evidence-based guidelines. “It maximizes the safety of a necessary blood transfusion and minimizes the need for transfusions through targeted interventions,” says O’Neal. These interventions include:

Anemia management to correct an iron or B12 deficiency before surgery to reduce the need for a transfusion
Using a cell saver to recycle a patient’s own blood during surgery

Though the terms “blood utilization” and “blood management” are sometimes used interchangeably, blood utilization is just one part of an overall blood management program. Blood utilization is also a requirement of accrediting agencies such as The Joint Commission as well as the Centers for Medicare & Medicaid Services.

“Every organization should have a blood utilization program, but not everyone has a patient blood management program that incorporates blood conservation, anemia management and optimizing coagulation with a patient-centered approach,” says O’Neal.

A successful patient blood management program puts the patient at its center and promotes empowerment by considering a patient’s needs and concerns when deciding to proceed with a transfusion. “When it’s not a trauma, and the patient can be involved in the discussion and choose whether or not to get a blood transfusion, we want them making informed decisions with the help of their physicians and caretakers,” explains O’Neal.

Reducing blood transfusions

By eliminating unnecessary blood transfusions, blood management programs improve patient outcomes and safety while also reducing costs for both patients and hospitals.

A blood management program reduces the risks associated with blood transfusions by proactively managing patients’ health and need for transfusions. “For example, work needs to be done on the front-end weeks prior to an elective surgery to ensure that a patient doesn’t have anemia. You can give certain pharmaceuticals to increase their red blood cell count and get their hemoglobin at the correct threshold for that procedure. This decreases the need for a blood transfusion,” explains Fortune.

Hospitals that implement a blood management program can expect to reduce the number of red cell unit transfusions by 20% to 30%, which translates to an equivalent cost savings, says O’Neal. “That’s total cost—not just the cost of the unit of blood itself. There’s the administration cost, the testing cost for the lab to get that unit ready for the patient, and the cost to store the blood with 24/7 monitoring in a temperature-controlled environment. So, there are a lot of expenses associated with transfusions, and when you can reduce those, it’s an overall cost reduction for the facility.”

A multidisciplinary approach

A successful blood management program brings together key stakeholders: clinicians and nursing staff from a variety of specialties, transfusion specialists, laboratory staff, the IT department, the quality department and pharmacy.

“When you consider treating a patient holistically, in healthcare that normally involves a multidisciplinary approach where you have all of the subject matter experts on the team to treat the whole patient, not just one component of the patient. This approach results in better patient outcomes,” explains Fortune.

As Director of Pharmacy Solutions and Member Support at HealthTrust, Fortune understands the expertise that pharmacists can bring to this multidisciplinary team. “Pharmacists are no longer thought of as the druggist in the basement counting the pills,” she says. “We have clinical functions that over time have grown because our value has been proven from a patient outcomes perspective.”

The use of pharmaceuticals to decrease the risk of transfusions is a vital component of a successful patient blood management program. Bringing pharmacy onto the blood management team provides the necessary medication expertise and ensures those drugs are available to minimize the need for transfusions.

Getting started

As beneficial as a patient blood management program is, Fortune and O’Neal recognize that starting one can be challenging. “Unfortunately, in the healthcare environment today, everyone is grasping at any cost savings. You have to understand the ROI and put together a clear business case,” adds Fortune.

Start by building awareness and explaining the benefits of a blood management program and identify leaders who will lend support. “Within a hospital, everyone knows a couple of physicians who are the go-to people because they’re passionate about safety and quality and are really good to work with. Those are the people you need to seek out early,” suggests O’Neal.

Evidence-based national guidelines and benchmarking to show how other hospitals are succeeding with a patient blood management program can help get buy-in from your leadership. Leadership support is important to access the funding and staffing resources your program will need.

O’Neal suggests starting small—perhaps with inpatient red cell unit transfusions—and building from there. “Once you show progress and savings from that, a part of those savings can be earmarked to be reinvested in the program. Maybe you branch out to an anemia clinic, or you’re able to purchase a piece of equipment for the OR. You can start small and keep adding to your program as you reinvest those savings.”

It doesn’t need to be overwhelming to develop a patient blood management program. HealthTrust offers members a free self-assessment tool that measures the maturity of a patient blood management program and helps to identify gaps.

“We’re able to meet clients wherever they are. From those not having a robust program to members who feel they need help optimizing an existing program—we have the subject matter experts on our team to take your program to a best-practice level,” Fortune adds.

Engage HealthTrust to review your blood management program from both a laboratory & pharmacy perspective. Contact your HealthTrust Account Manager or email thesource@healthtrustpg.com to start the conversation.

For more on blood supply, see Blood, Sweat & Tears.