SHERIDAN LEADERSHIP

BRIEF

BUILDING AND SUSTAINING A

BLOOD MANAGEMENT PROGRAM
How Creating and Implementing Standards for Transfusions Resulted
in Better Clinical Outcomes and Cost Savings for Hospitals

ANESTHESIOLOGY EMERGENCY NEONATOLOGY RADIOLOGY

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ANESTHESIOLOGY

INTRODUCTION
BLOOD TRANSFUSIONS ARE AMONG THE MOST COMMON
MEDICAL PROCEDURES at U.S. hospitals.1 But when it comes to this lifesaving
treatment, more is not always better.
EMERGENCY
costing between
Transfusions come with a higher risk of
mortality and other dangerous complications. $1.6 to $6.0
Transfusions are costly for hospitals. In a
2010 study published by Transfusion, a
MILLION
per hospital surveyed.
peer-reviewed academic journal, it was
estimated that blood transfusion costs range
from $522 to $1,183 per unit.2,3 The study also confirmed that blood transfusion-related
NEONATOLOGY costs for surgical patients are a significant resource drain - costing between $1.6 to
$6.0 million per hospital surveyed.3
Transfusions are managed differently from hospital to hospital. Even today, with more
than 15 million units of blood transfused per year in the United States, the practice is
not by any means a standardized process.2

Healthcare reform, reduced funds, rising blood costs, and the desire for better clinical
outcomes have exposed the need for effective blood management. A growing number of
RADIOLOGY
hospitals are instituting blood management programs, which are guidelines as to when
a transfusion is necessary or avoidable. A few forward-thinking hospitals prompted by
their physician partners who take the initiative are spearheading the efforts, studying the
impact, and developing the protocols.

This paper explains the need for blood management programs and how they can be
implemented at hospitals to save money and produce positive patient outcomes.

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 LEADERSHIP DRIVES PERFORMANCE PAGE 2

THE NEED FOR BLOOD MANAGEMENT PROGRAMS

ACCORDING TO THE JOINT COMMISSIONS STUDY on appropriate blood management,4
the following issues in patient blood performance measures (PBM) were noted:

Inconsistent Protocols
Informed consent for blood transfusions is not required by all states, and the consent
process varies between hospitals
Hospitals have different acceptable pre-transfusion lab values

Lack of national guidelines causes inconsistent use of transfusions

Its difficult to identify transfusions during surgery

Point-of-care testing is not used in all hospitals during surgery

Transfusion orders are usually not required or documented during surgery

Lack of Standardized Lexicon

Difficult to determine if documentation of clinical indication is sufficient

No standardized definition is used for bleeding

The order to transfuse is sometimes confused with the order to type and cross-match
in surgery

Inconsistent Education
Information about transfusion is not consistently given to patients

Information is provided by a variety of staff

Staff needs education about the risks, benefits and alternatives

 THE MANY COSTS OF BLOOD

Direct: Activity-Based:
The average acquisition cost for U.S. range is $726.05 to $1,183.325
one unit of red cells is $200.5

Indirect: Transfusions also affect:

Issuing and Delivering Length of stay

Testing Infection rates

Administration and Monitoring Complication rates

Inventory Management & Storage Mortality

Legal

TRANSFUSION PRACTICES VARY

GREATLY
A STUDY DONE BY THE INSTITUTE OF MEDICINE (IOM) SUGGESTS THAT
THERE IS WIDE VARIABILITY IN WHEN BLOOD TRANSFUSIONS ARE
PERFORMED. This is partly because the decision to transfuse is largely affected by non-clinical
factors in most cases. The evidence led the IOM to believe that transfusions in many hospitals may
seem necessary, but are in fact inappropriate.7,8

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 LEADERSHIP DRIVES PERFORMANCE PAGE 4

THE CREATION
OF BLOOD
MANAGEMENT
PROGRAMS
of all improvement initiatives within hospitals and health systems are
either wholly or partially dependent on doctors making them happen.
This was the case for anesthesiologist Robert Brooker, M.D., who championed a blood management
program at Memorial Healthcare in Hollywood, Fla.

THE TENETS9 OF THIS PROGRAMS ARE:

Work with cardiologists before surgery to make sure the patient is not on unnecessary
doses of blood thinners, which promote bleeding, and to ensure an anemic patient has
proper pre-op medicine

Draw a unit of blood from the patient the day of surgery, in case it is needed

Reduce the amount of plumbing in the heart/lung machine, keeping the patients
organs functioning during surgery so that it uses less blood-diluting fluids

Carefully ration IV fluids during surgery so the patients blood concentration does not
drop unnecessarily

Preserve and store red blood cells from blood thats lost during surgery, using a
suction device called a cell saver

Standardize the way anti-bleeding medications are given during surgery

Standardize what constitutes the transfusion threshold, or how far blood levels
can drop before triggering a decision to give the patient a transfusion
 CASE STUDY
MEMORIAL REGIONAL HOSPITAL (HOLLYWOOD, FLA.)
THE ADMINISTRATION AT MEMORIAL REGIONAL HOSPITAL in Florida had the goal
to develop a top-notch cardiac surgery program, an element of which was to make open heart surgery safer.
Sheridan anesthesiologist Dr. Robert Brooker, the hospitals chief of cardiac anesthesia, initiated a blood
conservation program to improve its
transfusion rates. Blood transfusions in heart surgery, or anywhere,
are only good for you if you really need it,
Cardiac surgery programs are under Dr. Brooker 9
increasing scrutiny to provide the highest
quality of care, and the rate of transfusions is
an important measurement of quality of care, Dr. Brooker.10

Blood transfusions in heart surgery, or anywhere, are only good for you if you really need it. Its like a liquid
organ transplant. If you dont absolutely need to have it to save your life, you shouldnt get it.
Dr. Brooker.9

IN 2008, THE HOSPITAL STARTED FOLLOWING AN ESTABLISHED

PROTOCOL and conducted a five-year study of the results of more than 1,000 patients. Dr. Brooker
presented the findings at the 2013 American Society of Anesthesiologists annual meeting.10

68% reduction
in cardiac patients needing surgical transfusions, from 59% to 19%

80% decrease
in the amount of blood needed, from 1.7 units to .33 units, saving $715.14 per unit

50% drop
in heart surgery-related deaths, infections, strokes and re-operations

100% decrease
in infections, falling from 3.2% to 0%

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 LEADERSHIP DRIVES PERFORMANCE PAGE 6

PHYSICIAN CHAMPIONS CHANGE

HOSPITALS
FOR THE BETTER
THE BLOOD MANAGEMENT PROGRAMS AT SEVERAL HOSPITALS, including the one outlined
in this paper, were instituted and championed by Sheridan physicians who believe that leadership drives performance
through integrity, excellence, creativity, teamwork and respect. Physician leaders at a hospital can greatly impact whether
change happens or not and whether change is successful or not. Sheridan physicians embody the necessary dedication to
collaborative leadership and hospital alignment needed in todays hospital environment.

To learn more about the processes behind various hospital initiatives and success stories, visit Sheridans Resource Center
online (www.sheridanhealhcare.com) for case studies, leadership briefs, and research and white papers. To discuss
how our performance-driven solutions can help increase efficiency and communication in your hospital, contact us at
THOUGHTLEADERSHIP@SHCR.COM or 855.252.2969.

REFERENCES:
1. Pfuntner, A., Wier, L. & Stocks, C. Most Frequent Procedures Performed in U.S. Hospitals, 2010. Healthcare Cost and Utilization Project. February, 2013. Retrieved from
http://www.hcup-us.ahrq.gov/reports/statbriefs/sb149.pdf
2. Frellick, M. Better blood management could be a boon for hospitals. Hospitals & Health Networks. September 1, 2012. Retrieved from http://www.hhnmag.com/display/
HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Magazine/2012/Sep/0912HHN_FEA_Trending
3. New Published Study Finds the Cost of Blood Transfusions is Significantly Under-Estimated, Establishes True Cost at $522 to $1,183 Per Unit. PR Newswire. April 5,
2010. Retrieved from http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aOnSySpePkI4
4. Rhamy, J. Accreditation Organizations Role in Reducing Overuse: Appropriate Blood Management Example. The Joint Commission Accreditation Laboratory. 2011.
5. Valenti, J. Cost Savings and Patient Blood Management. Society for the Advancement of Blood Management Annual Meeting. 2011. Retrieved from http://www.sabm.
org/sites/www.sabm.org/files/2011_am_valenti.pdf
6. Administrative and Clinical Standards For Patient Blood Management Programs The Society For the Advancement of Blood Management. Retrieved from http://www.
sabm.org/sites/sabm.org/files/Second-Edition-Draft-of-Administrative-and-Clinical-Standards-For-Patient-Blood-Management-Programs.pdf
7. Shander A, Goodnough LT. Blood transfusion as a quality indicator in cardiac surgery. JAMA; 304: 1610-1. 2010.
8. Shander A., et al. From Bloodless Surgery to Patient Blood Management. PBM Review. 2011.
9. Brochu, N. Memorial Regionals blood conservation efforts a success, hospital officials say. Sun-Sentinel. November 8, 2013. Retrieved from http://articles.sun-sentinel.
com/2013-11-08/health/fl-blood-transfusion-conservation-20131108_1_valve-surgery-transfusion-open-heart-surgery
10. Sheridan Healthcare Anesthesiologist to Present at ASA Annual Meeting. Business Wire. October 1, 2013. Retrieved from http://www.businesswire.com/news/
home/20131001005168/en/Sheridan-Healthcare-Anesthesiologist-Present-ASA-Annual-Meeting#.VRRfmPnF_YE
 About Sheridan Healthcare
SHERIDAN IS ONE OF THE LEADING PROVIDERS OF HEALTHCARE SOLUTIONS FOR ANESTHESIOLOGY AND OTHER SPECIALTIES
to physicians, hospitals and outpatient centers. Physician led and managed, Sheridan provides comprehensive clinical and
management solutions for anesthesia outsourcing and other specialty areas including emergency medicine, neonatology and
radiology. Our dedication to collaboration, leadership and quality provides our hospitals and patients with the care they deserve.

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