Improved outcomes and reduced costs associated with a health‐system–wide patient blood management program: a retrospective observational study in four major adult tertiary‐care hospitals

Abstract

BACKGROUND Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health‐system–wide PBM program. This study assesses program outcomes. STUDY DESIGN AND METHODS This was a retrospective study of 605,046 patients admitted to four major adult tertiary‐care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh‐frozen plasma (FFP), and platelet units transfused; single‐unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity‐based costs of transfusion; in‐hospital mortality; length of stay; 28‐day all‐cause emergency readmissions; and hospital‐acquired complications. RESULTS Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p < 0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity‐based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p < 0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p = 0.001). Single‐unit RBC transfusions increased from 33.3% to 63.7% (p < 0.001). There were risk‐adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67‐0.77; p < 0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84‐0.87; p < 0.001), hospital‐acquired infections (OR, 0.79; 95% CI, 0.73‐0.86; p < 0.001), and acute myocardial infarction‐stroke (OR, 0.69; 95% CI, 0.58‐0.82; p < 0.001). All‐cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02‐1.10; p = 0.001). CONCLUSION Implementation of a unique, jurisdiction‐wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product‐related cost savings.

Five‐year trends in perioperative red blood cell transfusion from index cases in five surgical specialties: 2011 to 2015

“…Important aspects of PBM include preoperative anemia treatment, intraoperative cell salvage and blood‐conservation techniques, antifibrinolytic drugs, point‐of‐care coagulation testing, minimization of hemodilution, and reduction of iatrogenic blood loss from laboratory testing . It has been demonstrated that PBM programs lower health care costs, decrease mortality, and reduce complications, including infections, myocardial infarctions, and strokes . Despite these advantages, formal PBM programs have not been adopted in some hospitals, because there are barriers to practice change and a lack of necessary resources.…”

“…In that cohort, the transfusion threshold also declined during the study period from 8.1 to 7.6 g/dL. PBM also has effectively reduced RBC transfusion in some surgical populations, including orthopedic surgery patients …”

Bloody Good! The Impact of eLearning on Medical and Nursing Practice

“…Somewhat paradoxically, retrospective analysis demonstrates that patients who are transfused often have worse outcomes, longer length-of-stay in hospital, and a higher rate of post-operative infection resulting in considerable additional costs to the health system [10].…”

The Global Developments in Transfusion Replacements and Patient Blood Management

“…In 2008, the Western Australia Department of Health implemented a comprehensive, health-system-wide PBM program based on the 3-pillar structure [10]. A recent report of 4 major tertiary hospitals in Australia (605,046 patients) showed that with a mean decrease of pre-transfusion hemoglobin levels from 7.9 g/dL to 7.3 g/dL (P＜0.001), a 41% decrease in transfused blood products and risk-adjusted reductions in hospital mortality, length-of-stay, hospital-acquired infections, acute myocardial infarction-stroke, and all-cause emergency readmission rates were observed [16]. Another study that analyzed health-related outcomes of a comprehensive PBM program observed reduced transfusion rates, hospital length-of-stay, and all-cause readmission rates [17].…”

“…PBM is a multidisciplinary, individualized approach to optimize patient outcome through the systematic implementation of effective and safe blood management strategies, including the minimization or elimination of unnecessary exposure to trans-fusions [9]. Several countries, such as Australia [10], the United States [11], and the United Kingdom Recent, long-term studies on fully operational PBM programs worldwide have shown overall improvements in patient outcomes, reduction in health care costs, and/or increased satisfaction by medical professionals [16,17]. In 2008, the Western Australia Department of Health implemented a comprehensive, health-system-wide PBM program based on the 3-pillar structure [10].…”