Saving our blood: A blood management approach in a regional hospital

Abstract

Background: Blood management strategies have been implemented in both Australia and overseas to reduce inappropriate blood use, exposure to blood products and indirectly reducing the number of adverse events.In 2011 the cost of blood products in Queensland was devolved from the state budget to each hospital and health service. Health services were then responsible to pay one-third of all fresh blood product cost, with the remaining two-thirds being funded by the federal government. The Sunshine Coast Hospital and Health Service (SCHHS) is a regional service with 4 public hospitals and 513 overnight beds.To address the challenges of maintaining a sustainable blood supply within the confinements of a devolved blood budget, a SCHHS blood management strategy was introduced to improve the appropriateness of transfusions practice. Aim: To assess the effectiveness of a blood management strategy in a regional hospital for the use of fresh blood products. Method: To improve appropriate blood use, the SCHHS Blood Management Committee in collaboration with the Queensland Blood Management Program developed and implemented an adult red cell single unit pathway and a two unit fresh frozen plasma pathway. Practice change was implemented by in-service training sessions, memos, meetings, emails and informal conversations. Compliance with the blood management strategy was monitored by blood bank laboratory scientists, the transfusion nurse and blood management committee members. Blood use, its appropriateness and transfusion related complications were tracked and reported at the SCHHS Blood Management Committee. The results for the period from July 2011 and June 2015 are reported below. Results: Red blood cell use reduced from 5119 units in 2011 to 4047 units in 2014.Fresh Frozen Plasma use reduced from 1339 units in 2012 to 716 units in 2014.Overall, from 2011 to 2015 the total fresh blood product use has continued to decline and significant cost saving to the Health Service blood budget have been achieved. These savings amount to approximately AUD $600,000.00. Transfusion related adverse events documented in the SCHHS incident reporting database (PRIME CI) have reduced significantly in alignment with the blood management strategies and reduced patient exposure to blood products. 48 adverse events were reported in 2013, 28 reported in 2014, and 21 reported in 2015, this is an overall reduction of 56%. Comparison of blood use by activity (WAU - Weighted Activity Unit) indicates that even though hospital activity is increasing, blood use has decreased by approximately 30%. Current SCHHS data indicates the cost of blood by WAU was approximately $11 in 2012/13 and has reduced to approximately $7 in 2014/15. Summary/Conclusion: The SCHHS data demonstrates that a blood management program including simple strategies such as single unit transfusions, complimented by promotion and education can significantly reduce blood use and transfusion related complications.L616935397 <br />