An electronic system that monitors how physicians give blood to patients after an operation has enabled the Salt Lake City, Utah-based Intermountain Healthcare to cut costs by $2.5 million over two years and contribute to lower infection rates.
The results are according to a study presented at the 2015 Clinical Congress of the American College of Surgeons. Intermountain implemented the blood ordering and tracking system, along with a program to educate hospital staffs, in 2012 to streamline blood transfusion protocols across its statewide system, explained study coauthor Mark J. Ott, M.D., a general surgeon and surgical oncologist who serves as chief medical director of Intermountain Healthcare’s central region, which includes Intermountain Medical Center, the system’s flagship facility.
“Blood is a drug, and everybody realizes blood does some wonderful things, but we don’t teach our students and residents in training how dangerous blood really is,” Dr. Ott said in explaining the rationale for the program. Transfused packed red blood cells act to suppress a recipient’s immune system, Dr. Ott explained. “Therefore, their risk of infection goes up, something that’s been documented in multiple studies.”
In 2011, six percent of all patients at Intermountain facilities received blood; today, only four percent do so, according to Dr. Ott. “So, a third of our patients didn’t get blood who used to. That’s a giant change,” he said. “That’s tens of thousands of units of blood a year that didn’t get used.” Study authors report that each unit of blood costs $300.
Before the program started, Intermountain facilities transfused almost 50 units of blood per 1,000 patient days. By June of this year, that rate had declined to about 35.5 units, a reduction of around 30 percent.
Another significant study finding was a sharp decline in the number of patients who received two units of blood, declining from 68 percent of all transfusion orders to 23 percent, exceeding the program goal of a 25 percent reduction, Dr. Ott said. “In medicine, there had been a mantra: ‘If you’re going to give one unit of blood, give two,’” he added.
Rates of hospital-acquired infections for both the general hospital population and patients who received blood declined significantly since Intermountain adopted the blood-tracking system. The overall infection rate was cut in half, from a rate of 1.66 to 0.81 per 1,000 patient days, while among patients who did receive blood, infection rates declined around 33 percent, study authors report. The reduction in infections was also impacted by other initiatives within the health system aimed at reducing surgical site infections and ambulating patients earlier after operations, the health system said.