Implementing a Health System-wide Patient Blood Management Program with a Clinical Community Approach

Steven Mark Frank, Rajiv N. Thakkar, Stanley J. Podlasek, K. H. Ken Lee, Tyler L. Wintermeyer, Will W. Yang, Jing Liu, Leo Rotello, Thomas A. Fleury, Pat A. Wachter, Lisa Earnest Ishii, Renee Demski, Peter J. Pronovost, Paul Michael Ness

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Patient blood management programs are gaining popularity as quality improvement and patient safety initiatives, but methods for implementing such programs across multihospital health systems are not well understood. Having recently incorporated a patient blood management program across our health system using a clinical community approach, we describe our methods and results.

METHODS: We formed the Johns Hopkins Health System blood management clinical community to reduce transfusion overuse across five hospitals. This physician-led, multidisciplinary, collaborative, quality-improvement team (the clinical community) worked to implement best practices for patient blood management, which we describe in detail. Changes in blood utilization and blood acquisition costs were compared for the pre- and post-patient blood management time periods.

RESULTS: Across the health system, multiunit erythrocyte transfusion orders decreased from 39.7 to 20.2% (by 49%; P < 0.0001). The percentage of patients transfused decreased for erythrocytes from 11.3 to 10.4%, for plasma from 2.9 to 2.2%, and for platelets from 3.1 to 2.7%, (P < 0.0001 for all three). The number of units transfused per 1,000 patients decreased for erythrocytes from 455 to 365 (by 19.8%; P < 0.0001), for plasma from 175 to 107 (by 38.9%; P = 0.0002), and for platelets from 167 to 141 (by 15.6%; P = 0.04). Blood acquisition cost savings were $2,120,273/yr, an approximate 400% return on investment for our patient blood management efforts.

CONCLUSIONS: Implementing a health system-wide patient blood management program by using a clinical community approach substantially reduced blood utilization and blood acquisition costs.

LanguageEnglish (US)
Pages754-764
Number of pages11
JournalAnesthesiology
Volume127
Issue number5
DOIs
StatePublished - Nov 1 2017

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Health
Quality Improvement
Multi-Institutional Systems
Blood Platelets
Erythrocytes
Time Management
Costs and Cost Analysis
Erythrocyte Transfusion
Cost Savings
Patient Safety
Practice Guidelines
Physicians

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Implementing a Health System-wide Patient Blood Management Program with a Clinical Community Approach. / Frank, Steven Mark; Thakkar, Rajiv N.; Podlasek, Stanley J.; Ken Lee, K. H.; Wintermeyer, Tyler L.; Yang, Will W.; Liu, Jing; Rotello, Leo; Fleury, Thomas A.; Wachter, Pat A.; Ishii, Lisa Earnest; Demski, Renee; Pronovost, Peter J.; Ness, Paul Michael.

In: Anesthesiology, Vol. 127, No. 5, 01.11.2017, p. 754-764.

Research output: Contribution to journalArticle

Frank, SM, Thakkar, RN, Podlasek, SJ, Ken Lee, KH, Wintermeyer, TL, Yang, WW, Liu, J, Rotello, L, Fleury, TA, Wachter, PA, Ishii, LE, Demski, R, Pronovost, PJ & Ness, PM 2017, 'Implementing a Health System-wide Patient Blood Management Program with a Clinical Community Approach' Anesthesiology, vol. 127, no. 5, pp. 754-764. https://doi.org/10.1097/ALN.0000000000001851
Frank, Steven Mark ; Thakkar, Rajiv N. ; Podlasek, Stanley J. ; Ken Lee, K. H. ; Wintermeyer, Tyler L. ; Yang, Will W. ; Liu, Jing ; Rotello, Leo ; Fleury, Thomas A. ; Wachter, Pat A. ; Ishii, Lisa Earnest ; Demski, Renee ; Pronovost, Peter J. ; Ness, Paul Michael. / Implementing a Health System-wide Patient Blood Management Program with a Clinical Community Approach. In: Anesthesiology. 2017 ; Vol. 127, No. 5. pp. 754-764.
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AU - Yang, Will W.

AU - Liu, Jing

AU - Rotello, Leo

AU - Fleury, Thomas A.

AU - Wachter, Pat A.

AU - Ishii, Lisa Earnest

AU - Demski, Renee

AU - Pronovost, Peter J.

AU - Ness, Paul Michael

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N2 - BACKGROUND: Patient blood management programs are gaining popularity as quality improvement and patient safety initiatives, but methods for implementing such programs across multihospital health systems are not well understood. Having recently incorporated a patient blood management program across our health system using a clinical community approach, we describe our methods and results.METHODS: We formed the Johns Hopkins Health System blood management clinical community to reduce transfusion overuse across five hospitals. This physician-led, multidisciplinary, collaborative, quality-improvement team (the clinical community) worked to implement best practices for patient blood management, which we describe in detail. Changes in blood utilization and blood acquisition costs were compared for the pre- and post-patient blood management time periods.RESULTS: Across the health system, multiunit erythrocyte transfusion orders decreased from 39.7 to 20.2% (by 49%; P < 0.0001). The percentage of patients transfused decreased for erythrocytes from 11.3 to 10.4%, for plasma from 2.9 to 2.2%, and for platelets from 3.1 to 2.7%, (P < 0.0001 for all three). The number of units transfused per 1,000 patients decreased for erythrocytes from 455 to 365 (by 19.8%; P < 0.0001), for plasma from 175 to 107 (by 38.9%; P = 0.0002), and for platelets from 167 to 141 (by 15.6%; P = 0.04). Blood acquisition cost savings were $2,120,273/yr, an approximate 400% return on investment for our patient blood management efforts.CONCLUSIONS: Implementing a health system-wide patient blood management program by using a clinical community approach substantially reduced blood utilization and blood acquisition costs.

AB - BACKGROUND: Patient blood management programs are gaining popularity as quality improvement and patient safety initiatives, but methods for implementing such programs across multihospital health systems are not well understood. Having recently incorporated a patient blood management program across our health system using a clinical community approach, we describe our methods and results.METHODS: We formed the Johns Hopkins Health System blood management clinical community to reduce transfusion overuse across five hospitals. This physician-led, multidisciplinary, collaborative, quality-improvement team (the clinical community) worked to implement best practices for patient blood management, which we describe in detail. Changes in blood utilization and blood acquisition costs were compared for the pre- and post-patient blood management time periods.RESULTS: Across the health system, multiunit erythrocyte transfusion orders decreased from 39.7 to 20.2% (by 49%; P < 0.0001). The percentage of patients transfused decreased for erythrocytes from 11.3 to 10.4%, for plasma from 2.9 to 2.2%, and for platelets from 3.1 to 2.7%, (P < 0.0001 for all three). The number of units transfused per 1,000 patients decreased for erythrocytes from 455 to 365 (by 19.8%; P < 0.0001), for plasma from 175 to 107 (by 38.9%; P = 0.0002), and for platelets from 167 to 141 (by 15.6%; P = 0.04). Blood acquisition cost savings were $2,120,273/yr, an approximate 400% return on investment for our patient blood management efforts.CONCLUSIONS: Implementing a health system-wide patient blood management program by using a clinical community approach substantially reduced blood utilization and blood acquisition costs.

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