I was at a dinner meeting not too long ago with a group of colleagues that were seasoned perfusionists. The question came up about my role in Blood Management with Perfusion.com. Before I could answer, another perfusionist responded “Oh, that’s setting up an autotransfusion program.” Another time, one of my physician champions and I were discussing the importance of setting up a Blood Management program with Pathology and the Lab Directors. The response usually is that “we already have a Transfusion Committee at our institution”. When in dialogue with corporate leaders, for the most part, they all have a different definition of what they believe constitutes a Blood Management program. Unfortunately, these are some of the more common misconceptions of what blood management is all about. Hopefully, in the next few paragraphs, I can provide my readers with a broader scope of practice of implementing and applying a hospital-wide Blood Management program.
The first step is to have that champion within the organization who has the passion and leadership to go that extra mile. This individual should have a complete understanding of Blood Management. This is accomplished by reviewing evidence-based literature, video presentations and consulting with leaders in the field. This individual should be able to express how this program would improve the quality of care to patients and be able develop a business plan accordingly. Without this initial groundwork, any Blood Management program will fail. I realize this is a lot of work, but a quote from General George Patton succinctly sums it up: “An ounce of sweat will save a gallon of blood.”
The second step is to present this plan to the audience of stakeholders at your organization. These important individuals should consist of Medical and Administrative Directors from Blood Bank, Administration VP or above, champion Physicians from at least two service lines (Chief Medical Officer, Pathology or Transfusion Committee Chairman) and someone from Quality or Risk Management. Think of these individuals as customers of your Blood Management product line. Your job is to outline and define a multidisciplinary approach as it applies to that organization and to present a clear blueprint of the team members, strategies, policies, procedures and tools that exist (or don’t exist) within the organization. It is also your job to demonstrate how this process applies to everybody in the clinical setting; both preoperatively, intraoperatively and postoperatively. Every patient that walks through the doors should be considered a candidate for Blood Management.
The third step is providing a system to collect data and monitor progress. Our main goal is the quality and outcomes of our patients, but financial savings provide a huge part in the success or failure of the program. Once implemented, a successful Blood Management should reduce transfusion of blood products by approximately 20%. Therefore, collecting a 12 month history in transfusion practice is crucial. Remember old habits are hard to break. You need ongoing data measurement information to guide transfusion practices and change behavior. In most of our programs, we have developed a formula looking at the direct and indirect cost and utilization of blood products. In the cardiac service line, one benchmarking tool is the STS Registry data on intraoperative and postoperative use of blood products. At Perfusion.com, we can monitor the use of blood products by surgeons and perfusionists on a case-by-case basis and provide quarterly summary reports. Haemonetics has a program called Impact Online which provides in-depth and hospital-wide reports on blood product utilization. This comprehensive blood management portal provides a panoramic view based on analysis, trends and clinical outcomes in comparison to other benchmark programs. This program will allow institutions to customize dashboards and physician scorecards and even look at the age of blood being transfused. The golden key to success is having some form of data management system at your program.
Hopefully, all of your hard work has paid off and a commitment from the organization to move ahead has been granted. If not, shame on the organization. They have not only missed the boat with regard to financial savings, but also for improving patient care and safety. The next step, which is a whole new ball game and topic, is to form your blood management committee, find your champions and schedule your meetings.
Finally, I would like to mention that the rewards, recognition and camaraderie of a Blood Management Program are substantial. It eliminates the silo effects, and allows individual departments to learn from one another. It takes commitment, teamwork and most of all continuous education. Much like a finely tuned Italian bike, you must have a true rim to stay on track. Each spoke, much like your topics of discussion, needs to be finely tuned to give you that ultimate ride. By working as a team, you will ride through peaks and valleys; but by drafting off of each other you will win the race. That is ultimate goal of achieving outstanding patient care, and the true winner of the race will be your patient.
Once again, we welcome any question, comments or suggestions regarding this or another topic that you would like to see addressed here.
C. Ty Walker, CPBMT, CCP
Blood Management Director