Using Blood Wisely
Patient blood management (PBM) has been a focus for the University of Pittsburgh Medical Center (UPMC) for many years, though the health system’s expansion has made it more challenging to promote the same evidence-based transfusion approach.
During the last four years, UPMC leveraged strong C-suite support and a PBM physician champion to yield a 32 percent reduction in non-evidence based transfusions and cost savings of $10 million. The system is also including multiple stakeholders, including patients, for continues success in blood management.
With a strategy developed by the program’s medical director, Dr. Jonathan Waters, each of UPMC’s 42 hospitals have embraced the PBM program. The strategy includes six key components:
- Leverage computerized physician order entry systems to guide evidence-based transfusions.
- Reduce all forms of waste related to blood transfusion practices.
- Promote alternative blood transfusion methods and systems.
- Promote anemia management strategies.
- Limit iatrogenic blood loss.
- Provide blood management education, awareness and auditing for clinicians, as well as patient-centered shared decision-making tools.
Throughout the health system, blood management champions, including Dr. Waters, Chief Quality Officer Tami Minnier, RN, and Dr. Steven Shapiro, leveraged strong connections with colleagues to communicate why a liberal approach to blood use may not be helping patients and why a conservative approach is just as effective.
Sharing evidence around overuse of blood along with clinical guidelines, including Choosing Wisely recommendations from the American Association of Blood Banks, were critical in raising physician awareness and encouraging behavior change. UPMC also took the opportunity to learn from patients who refused transfusions and found that it was possible to practice “bloodless medicine” for a wider population.
With the framework in place and clinicians across UPMC invested in the effort, collaborating with the IT team to gather and disseminate data drove behavior change. After determining areas of variation, the team worked to add alerts in the electronic health record so that when clinicians ordered blood, they needed to provide a rationale. This information helped the team determine why units of blood were ordered and which service lines were ordering the most.
In addition to decision support tools, UPMC used its organizational dashboard, which provides metrics, to update hospitals and clinicians about ordering habits, blood utilization and how many alerts were triggered and ignored. Over time, they tracked fewer transfusions and less variability, and found that after a period when the alerts were in place, clinicians were no longer ordering blood certain scenarios.
Mary Kay Wisniewski, the program’s administrative director, said that the 32 percent reduction in unwarranted transfusions equates to fewer patients at risk for adverse events.
UPMC is also wasting far less blood than national averages after launching a blood waste prevention campaign in 2014. Part of the success was that the team communicated about blood waste in tangible terms by asking clinicians how they would feel if they just donated blood and then watched someone throw it away.
The work and commitment to evidence-based transfusion practices at UPMC has been featured in journal articles and has been presented at national and international meetings.
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