Minn. hospitals 'doing more with less blood'

How one system used 14,000 fewer units of blood—and why it helped patients

Topics: Cardiovascular, Service Lines, Surgery, Appropriateness, Quality, Performance Improvement, Access to Care, Patient Experience, Mortality, Safety

October 23, 2013

Hospitals in the St. Paul-Minneapolis area have cut their use of donated blood by thousands of units over the last five years by adhering to new recommendations for patients' hemoglobin levels and other tactics, the Twin Cities Star-Tribune reports.

Changing the requirements for transfusions

To decrease their use of donated blood, hospitals have adjusted the hemoglobin level that trigger a transfusion.

A healthy hemoglobin level in an adult is around 13 grams per deciliter. Hospital generally order a transfusion if a patient's level drops to 10 or eight, but Twin Cities hospitals now do not order transfusions unless readings are as low as seven. (The American Association of Blood Banks adopted that minimum as part of their formal guidelines last year.)

Officials from Allina Health say that the move has reduced the amount of donated blood used by 14,000 units since January 2010 at its 12 hospitals.

"If you're bleeding out, blood is going to save your life," says Lauren Anthony, a pathologist who led Allina's effort, adding that "if you're not bleeding out, blood is not as beneficial as they used to think it was."

The change has also resulted in lower care costs, because each transfusion costs hundreds of dollars and puts patients at risk of ­complications, such as hypervolemia, which occurs when a patient has too much blood in their veins.

Using less blood per transfusion

In addition, area hospitals are using less blood per transfusion. Hospitals have long given patients two units of blood per transfusion, but Twin Cities hospitals give them just one unit. The old standard was largely based on flawed logic, Anthony says, adding that studies since have proven that single-unit transfusions are equally effective and safer.

The recommendation has been championed under the slogan "Why Give 2 When 1 Will Do," words that appear on posters in hospitals throughout the area.

At Allina, officials took it a step further, Anthony says. The system produced a parody film called the "Blood Police" in which a "cop"—played by a perfusionist—"pulls over" physicians and nurses for ordering unnecessary transfusions.

Pathologist Kathrine Frey tells the Star Tribune that she feels like she has become a real-life blood cop at Fairview Southdale Hospital, where staff have worked to cut the hospital's blood usage by 3,000 units each year. Frey has a stack of cardboard boxes that approximate the red blood units used unnecessarily each year—called "blood mountain"—to teach a visual lesson to staff.

"This has been the most joyful, rewarding work I have ever done," says Frey, adding "because you can really see the difference. You bring the blood units down, you know the patients are safer and you save the hospital significant money" (Olson, Twin Cities Star Tribune, 10/21).

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