Since 2012, we have been publishing a Utilization Spotlight in every issue of the Communiqué. Each Spotlight offers a quick view of utilization management best practices in action. This Spotlight is from March 2013.
Rapid City Regional Hospital (RCRH), a 417 bed hospital located in the Black Hills of South Dakota, identified a marked increase in the use of blood products and associated costs at a time when blood components were in short supply. After hearing James Stubbs, M.D., medical director of transfusion medicine at Mayo Clinic Rochester, speak about best practices and the financial impact of transfusion medicine costs, RCRH implemented a blood management program to decrease blood usage.
Rapid City Regional Hospital (RCRH) is a 417 bed hospital located in the Black Hills of South Dakota. RCRH provides a wide variety of services to patients including emergency services, heart and vascular care, labor and delivery, pain management, stroke care, and surgery.
RCRH identified a marked increase in the use of blood products and associated costs at a time when blood components were in short supply. By conducting an internal review of the administration of red blood cells (RBC), they discovered that use at RCRH was 3 times higher than a comparative group; administration of fresh frozen plasma (FFP) was 2.5 times higher and platelet use was 4.5 times greater than that of the comparative group.
By some accounts, 30 to 70 percent of transfusions ordered by physicians in community and academic hospitals are inappropriate. The excessive use of blood components not only results in unnecessary increased costs but also exposes patients to perioperative risks due to transmission of infectious diseases, volume overload, transfusion-related acute reactions, immunomodulation, and transfusion-related acute lung injury (TRALI). Because of their cost, their limited availability, and the potentially harmful adverse events, appropriate utilization of blood products based on established transfusion guidelines is essential.
Goals of the Program
Any blood management program must be evidence-based, follow a multidisciplinary process, and be designed to promote optimal use of blood products, with the goal of providing the right component at the right dose for the right reason at the right time. The goals of the RCRH blood management program were to:
- Reduce the financial impact of blood product administration
- Utilize evidence-based practice to decrease the number of inappropriately transfused blood products
- Continue to communicate and educate providers in the administration of blood products
- Refine the blood product ordering process to reflect best practice methods.
James Stubbs, M.D., medical director of transfusion medicine at Mayo Clinic Rochester, was invited to RCRH to present Transfusion Therapy in Selected Clinical Situations to highlight best practices and describe the financial impact of transfusion medicine costs.
With knowledge and insight gained from Dr. Stubbs’ presentation, an interdisciplinary team was formed to address the issues. Team members included laboratory leadership, a clinical quality team, nursing, and physician champions. The team reviewed literature to identify evidence-based practices to develop and implement order sets and computer order entry. These practices were communicated to the medical staff using the RCRH intranet, staff meetings, and other education resources. Monitoring systems for transfusion use and staff compliance were developed and implemented.
With this program in place, RCRH has decreased blood usage while focusing on patient safety and quality care. Packed red blood cell usage was reduced by 22 percent the first year and by another 11 percent the second year, resulting in a total cost savings of $709,236. The transfusion team at RCRH continues to work on this initiative. Current efforts also focus on providing timely data to the care team in order to establish a real-time dialogue regarding the appropriateness of transfusions. The goal is to build a strong relationship between the transfusion laboratory and care providers while continuing to reinforce evidence-based practice solutions.
The success of this initiative demonstrates that use of a multidisciplinary approach with continued communication and education based on an evidence-based process with clear accountability can decrease health care costs while maintaining quality patient care.