Relative impact of a patient blood management program on utilization of all three major blood components

Rajiv N. Thakkar, K. H Ken Lee, Paul Michael Ness, Tyler L. Wintermeyer, Daniel J. Johnson, Jing Liu, Anjuli Rajprasad, Amy M Knight, Pat A. Wachter, Renee Demski, Steven Mark Frank

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Although patient blood management (PBM) programs clearly reduce transfusion overuse, the relative impact on red blood cell (RBC), plasma, and platelet (PLT) utilization is unclear. STUDY DESIGN AND METHODS: A retrospective analysis of electronic records was conducted at a medium-sized academic hospital to assess blood utilization for all inpatients admitted during 1-year periods before (n = 20,531) and after (n = 19,477) PBM efforts began in September 2014. Transfusion guideline compliance and overall utilization were assessed for RBCs, plasma, and PLTs. The primary PBM efforts included education on evidence-based transfusion guidelines, decision support in the computerized provider order entry system, and distribution of provider-specific reports showing comparison to peers for guideline compliance. Cost avoidance was determined by two methods (acquisition cost and activity-based cost), and clinical outcomes were compared during the two periods. RESULTS: For RBCs, orders outside hospital guidelines decreased (from 23.9% to 17.1%, p < 0.001), and utilization decreased by 12% (p < 0.035). For plasma and PLTs, both orders outside guidelines and utilization changed minimally. Overall cost avoidance was $181,887/year by acquisition cost (and from $582,039 to $873,058/year by activity-based cost), 93% of which was attributed to reduction in RBC utilization. Length of stay, morbidity, and mortality were unchanged. CONCLUSIONS: Our findings demonstrate a greater opportunity for reducing RBC compared to plasma and PLT utilization. A properly implemented PBM program has potential to reduce unnecessary transfusions and their associated risk and costs, without compromising clinical outcomes.

Original languageEnglish (US)
Pages (from-to)2212-2220
Number of pages9
JournalTransfusion
Volume56
Issue number9
DOIs
StatePublished - Sep 1 2016

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Costs and Cost Analysis
Guidelines
Erythrocytes
Compliance
Medical Order Entry Systems
Blood Platelets
Inpatients
Length of Stay
Morbidity
Education
Mortality

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

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Relative impact of a patient blood management program on utilization of all three major blood components. / Thakkar, Rajiv N.; Lee, K. H Ken; Ness, Paul Michael; Wintermeyer, Tyler L.; Johnson, Daniel J.; Liu, Jing; Rajprasad, Anjuli; Knight, Amy M; Wachter, Pat A.; Demski, Renee; Frank, Steven Mark.

In: Transfusion, Vol. 56, No. 9, 01.09.2016, p. 2212-2220.

Research output: Contribution to journalArticle

Thakkar, RN, Lee, KHK, Ness, PM, Wintermeyer, TL, Johnson, DJ, Liu, J, Rajprasad, A, Knight, AM, Wachter, PA, Demski, R & Frank, SM 2016, 'Relative impact of a patient blood management program on utilization of all three major blood components', Transfusion, vol. 56, no. 9, pp. 2212-2220. https://doi.org/10.1111/trf.13718
Thakkar, Rajiv N. ; Lee, K. H Ken ; Ness, Paul Michael ; Wintermeyer, Tyler L. ; Johnson, Daniel J. ; Liu, Jing ; Rajprasad, Anjuli ; Knight, Amy M ; Wachter, Pat A. ; Demski, Renee ; Frank, Steven Mark. / Relative impact of a patient blood management program on utilization of all three major blood components. In: Transfusion. 2016 ; Vol. 56, No. 9. pp. 2212-2220.
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T1 - Relative impact of a patient blood management program on utilization of all three major blood components

AU - Thakkar, Rajiv N.

AU - Lee, K. H Ken

AU - Ness, Paul Michael

AU - Wintermeyer, Tyler L.

AU - Johnson, Daniel J.

AU - Liu, Jing

AU - Rajprasad, Anjuli

AU - Knight, Amy M

AU - Wachter, Pat A.

AU - Demski, Renee

AU - Frank, Steven Mark

PY - 2016/9/1

Y1 - 2016/9/1

N2 - BACKGROUND: Although patient blood management (PBM) programs clearly reduce transfusion overuse, the relative impact on red blood cell (RBC), plasma, and platelet (PLT) utilization is unclear. STUDY DESIGN AND METHODS: A retrospective analysis of electronic records was conducted at a medium-sized academic hospital to assess blood utilization for all inpatients admitted during 1-year periods before (n = 20,531) and after (n = 19,477) PBM efforts began in September 2014. Transfusion guideline compliance and overall utilization were assessed for RBCs, plasma, and PLTs. The primary PBM efforts included education on evidence-based transfusion guidelines, decision support in the computerized provider order entry system, and distribution of provider-specific reports showing comparison to peers for guideline compliance. Cost avoidance was determined by two methods (acquisition cost and activity-based cost), and clinical outcomes were compared during the two periods. RESULTS: For RBCs, orders outside hospital guidelines decreased (from 23.9% to 17.1%, p < 0.001), and utilization decreased by 12% (p < 0.035). For plasma and PLTs, both orders outside guidelines and utilization changed minimally. Overall cost avoidance was $181,887/year by acquisition cost (and from $582,039 to $873,058/year by activity-based cost), 93% of which was attributed to reduction in RBC utilization. Length of stay, morbidity, and mortality were unchanged. CONCLUSIONS: Our findings demonstrate a greater opportunity for reducing RBC compared to plasma and PLT utilization. A properly implemented PBM program has potential to reduce unnecessary transfusions and their associated risk and costs, without compromising clinical outcomes.

AB - BACKGROUND: Although patient blood management (PBM) programs clearly reduce transfusion overuse, the relative impact on red blood cell (RBC), plasma, and platelet (PLT) utilization is unclear. STUDY DESIGN AND METHODS: A retrospective analysis of electronic records was conducted at a medium-sized academic hospital to assess blood utilization for all inpatients admitted during 1-year periods before (n = 20,531) and after (n = 19,477) PBM efforts began in September 2014. Transfusion guideline compliance and overall utilization were assessed for RBCs, plasma, and PLTs. The primary PBM efforts included education on evidence-based transfusion guidelines, decision support in the computerized provider order entry system, and distribution of provider-specific reports showing comparison to peers for guideline compliance. Cost avoidance was determined by two methods (acquisition cost and activity-based cost), and clinical outcomes were compared during the two periods. RESULTS: For RBCs, orders outside hospital guidelines decreased (from 23.9% to 17.1%, p < 0.001), and utilization decreased by 12% (p < 0.035). For plasma and PLTs, both orders outside guidelines and utilization changed minimally. Overall cost avoidance was $181,887/year by acquisition cost (and from $582,039 to $873,058/year by activity-based cost), 93% of which was attributed to reduction in RBC utilization. Length of stay, morbidity, and mortality were unchanged. CONCLUSIONS: Our findings demonstrate a greater opportunity for reducing RBC compared to plasma and PLT utilization. A properly implemented PBM program has potential to reduce unnecessary transfusions and their associated risk and costs, without compromising clinical outcomes.

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