Reducing Wastage of Blood and Blood Products in Hospitals

There are two basic ways to reduce wastage of blood and blood products in hospitals. First and focusing on processes that are internal to the blood bank, improved inventory control can reduce outdating of blood. One example of such a process is the maximum surgical blood order schedule (MSBOS) (see: Hospitals Seek to Limit Blood Transfusions as a Cost-Saving Measure). The MSBOS has been widely used and accepted around the world for 35 years. A second approach is to persuade or apply pressure on blood-transfusing physicians to alter their clinical transfusion criteria such that the blood or blood products they would normally transfuse in marginal cases are eliminated. Not only does this latter approach save money, it also conserves scarce resources and reduces the health risk for patients of transfusion-associated infectious diseases. Columbia Healthcare Analytics offers consulting services to hospitals and pathologists for reducing inappropriate blood use by clinicians. Here's a summary of their services copied from the company's web site:

Columbia Healthcare Analytics...provides web-based Interactive External Utilization Review (IEUR) of hospital blood usage and other resources, including peer review, for the healthcare industry. [The company] has re-engineered UR and peer review through innovative use of information technology. Our solutions replace ineffective business processes that restrict healthcare organizations from achieving optimal and cost-effective patient care. Our innovative information technology...permits CHA to review all events, whether it be UR of all blood transfusions, diagnostic test orders or chart documentation. Effective 100% UR results in immediate reduction of resource usage, as high as 15% in the first few months. Immediate reduction of resource usage and reasonable CHA fees create a virtually instantaneous return on investment for healthcare clients.

Here's a summary of the fee structure for CHA consulting services:

A number of hospital charts are selected at random. Typically IEUR of 100 charts is recommended, but as few as 20 charts or as many as one month’s sample may be selected. The fee for Phase I is $190 per chart. This includes a critique of each chart, the results of which can be reviewed by the hospital, the transfusion committee, each department chair and each involved ordering physician..... Potential systemic hospital utilization problems are identified, as well as constructive feedback provided on individual cases to improve physician practice. It is anticipated that this feedback alone may reduce blood usage by at least a few percent, which more than pays for the $19,000 fee to perform a 100 chart review. Upon completion of Phase I, a proposal with detailed cost-benefit analysis will be submitted to the hospital to perform Phase II UR.

If you were to ask me what would happen to blood utilization in a hospital in the midst of an external (or internal, for that matter) review of blood transfusion practices, I would say that it would be immediately reduced by at least ten percentage points. This, in fact, is roughly the assertion made by Columbia in their web site for their "exploratory utilization review" stage. Additional costs are incurred for the following intensive and maintenance utilization reviews, also detailed on the web site. So far, so good.

If the leadership of a hospital pathology department has a desire to decrease blood wastage, it seems to me that the first logical step would be to improve internal work flow processes including inventory control. If there is the political will and mandate to also examine the transfusion practices of the blood-ordering physicians in the hospital, a case can be made for using the services of consultants from CHA. If such scrutiny causes political backlash among hospital physicians, the pathology department can distance themselves from the results with a loss to the institution of only the CHA consulting fees.

I personally would recommend instead an internal hospital-wide review of clinical transfusion practices. Such an "internal dialogue" could result in useful information about the transfusion needs and habits of clinicians, particularly surgeons, and produce gradual changes in behavior without the fear of penalties for non-compliance. Such a process would be harder to walk away from than recommendations from an external consultant, who could be said to lack an understanding of "local medical practices."

Comments

[Carol]

Apparently, there is not a place that is 100% sterile. There will always be a breach on it. However, these breach should be tolerable because if they are not, it may cause infectious diseases to the patients who got exposed to it.

[bariatric surgery]

Hospitals and public health care units are supposed to safeguard the health of the community. However, the waste produced by the medical care centers if disposed off improperly, can pose an even greater threat than the original disease ... The most significant risk associated with clinical waste is transmission of a blood borne virus from a needle stick injury.So as they are taking the care they should still more measures to remain more hygienic.

[Barry Portugal, Health Care Development Services, Inc.]

It's been our experience that, most often, benefits of "internal hospital-wide reviews" to reduce unnecessary blood utilization have a half life of about the time it takes the surgeons to walk to the parking lot. We have been helping laboratory administrators, pathologists, and hospital administrators organize and operate hospital laboratories more effectively for over 25 years, and it's our view that the only way blood utilization peer review can be successful in the long term is to outsource the process, and then to regularly monitor utilization. As part of our operations and financial audits of hospital laboratories, we have worked with other consultants who have assisted transfusion committees implement substantial and sustained reductions in unnecessary blood transfusions. The benefits of having an outside, objective review is that it produces objective, impartial results.