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Avoiding Blood Transfusion as a Hospital Quality and Cost-Savings Measure

Posted Jan 11 2013 12:00am

Tucked into a recent news article about the use of multidisciplinary teams (MDTs) at the Cleveland Clinic was the interesting mention of the goal of reducing blood transfusion as both a cost-savings measure and to reduce complications and survival after heart surgery (see:  Approaching Illness as a Team ). Below is the relevant paragraph:

Data analysis to evaluate how well treatments work is also a big part of the [Cleveland Clinic] medical practice. For instance, the clinic analyzed outcomes for heart surgery patients and found that those who had received blood transfusions during surgery had higher complication rates afterward and a lower long-term survival rate. As a result, it has adopted strict guidelines that limit the use of transfusions. Such judgments about a treatment’s effectiveness are made by doctors, not by financial administrators, so they tend to be accepted....At the same time, the clinic has also carried out simpler reforms, like improving sterile conditions, which has reduced catheter-related bloodstream infections by more than 40 percent and urinary tract infections by 50 percent. All this has happened in a remarkably short time.

All physicians know that there are a number of potential adverse consequences associated with blood transfusions not the least of which is the transmission of infectious diseases (see: Blood transfusion ). Blood suppliers and hospital blood banks, of course, run a battery of tests on crossmatched units of blood and components to try to avoid such complications as well as major incompatibility problems.

The statement above that patients who "received blood transfusions during surgery had higher complication rates afterward and a lower long-term survival rate" is quite dramatic and could probably be challenged. However, the fact that it even appeared in an article about the Cleveland Clinic's quality/cost containment initiatives, in my mind, is highly significant. I am seeing a number of other similar article in prestigious journals (see, for example: GI Bleeding: Withholding Transfusion Boosts Survival ). 

The major reason that I helped to develop the Maximum Surgical Blood Order Schedule (MSBOS) several decades ago was to reduce the excessive number of units of blood that were crossmatched, stored in OR refrigerators, and never transfused (see: Hospitals Seek to Limit Blood Transfusions as a Cost-Saving Measure ). However, another more subtle goal was to reduce the number of units transfused to patients simply because they were available in the OR refrigerators. I will see if I can get more information about the new "strict [blood transfusion] guidelines" that have been adopted by the Cleveland Clinic. I am enthusiastic about any measures that reduce unnecessary blood transfusion.

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