3 Blood Management Programs for Addressing America’s Transfusion Problem
health system patient blood management, patient blood management program, blood transfusion utilization, appropriate blood utilization, inappropriate blood transfusions, hospital patient blood management, blood transfusion guidelines, restrictive blood management, restrictive blood management program, restrictive transfusion program, red blood cell transfusion, red blood cell transfusion guidelines” width=”150″ height=”150″ />There are a few different types of blood management programs that offer solutions to the US’ blood transfusion problem. The Society for Advancement of Blood Management states that a restrictive blood transfusion approach is now best practice. These guidelines identify a hemoglobin (Hgb) of 7 or below as the most common transfusion trigger. However, there are higher thresholds for specific clinical situations, like trauma, coronary disease, and cardiac surgery, for example.
The American Board of Internal Medicine’s Choosing Wisely campaign had different specialties identify interventions that should never be done — or should at least be seriously questioned by physicians and patients. One of the five items in the list compiled by the Society of Hospital Medicine relates to the transfusion of red blood cells. It states that red blood cells should never be transfused for an arbitrary Hgb or hematocrit threshold unless there are symptoms of coronary disease, heart failure, or stroke. This is an example of a situation where restrictive transfusion is deemed best practice. There are dozens of clinical trials, and yet, half of all transfusions are still inappropriate.
“Avoid transfusion of red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms or active coronary disease, heart failure, or stroke.”
The good news is that there are programs available to address the blood transfusion problem.
- Implementation of New Guidelines
One easy way to begin is by educating physicians through some simple approaches about the idea of simple thresholds of Hgb of 7 or below. You don’t transfuse, in general, without a hemoglobin of 7 or below. Furthermore, you don’t start with two units; you start with one. Then, you repeat the Hgb test afterwards and take it from there. Hospitals can begin with just this restrictive guideline approach and see quite a bit of improvement, although it will be incremental.
- Restrictive Blood Programs
To expand beyond guidelines into a restrictive blood program involves a multidisciplinary team of blood banks, pathologists, clinicians, and others, leveraging informatics for further decision support. A critical component of any utilization management program, including in lab testing, is providing physicians with feedback in the form of dashboards and reports, to show them how they’re doing over time, as well as how they’re doing compared to their peers. This has been shown to be very effective in utilization management, including in blood transfusions.
- Patient Blood Management
The most effective blood management program is known as patient blood management (PBM), which is an institution-wide program that really tackles the Institute of Medicine’s Triple Aim. This involves things like pre-operative anemia treatment, hemostasis management, and transfusion management. It requires quite a bit of analytics and informatics, and there’s a patient-centered component to it, which means providing patients with options and involving them in the decision making.
To learn more, download “Advanced Lab Analytics for Patient Blood Management Programs“.