The Department of Anesthesiology’s patient blood management program is pushing for federal legislation requiring hospitals that receive federal support to educate physicians about alternatives to blood transfusion and ways to reduce risk by using a patient’s own blood.
Bruce D. Spiess, MD, FAHA, traveled to the U.S. Congress on July 30 to present a legislative roadmap to the staffs of Rep. Andy Harris, R-MD, Rep. Frank Pallone Jr., D-NJ, chairman of the House Energy and Commerce Committee, and local Rep. Ted Yoho, R-FL.
Since then, Dr. Spiess has had several additional conversations with delegates and hopes to give presentations to the U.S. and Florida surgeon generals. While it will likely take time for the legislation to become law, Dr. Spiess is optimistic.
“It appears to be a bipartisan issue,” he said.
Patient blood management is an evidence-based, multidisciplinary initiative that seeks to improve patient outcomes and population health and lower costs per capita by encouraging appropriate transfusions.
Experts say that 40% to 60% of blood transfusions are unnecessary, calling transfusions “a therapy in search of a disease” that can put patients at risk for infections and other complications associated with introducing a foreign substance to the body.
“Giving someone a transfusion is really like giving someone a transplant,” said Mary Jane Michael, RN, BSN, MS, CCRC, Manager of Clinical Research, who runs UF’s patient blood management program, “Practicing Excellence in Transfusion” (PETGators), with Dr. Spiess.
The legislation would tie federal funding for hospitals and health care systems to ongoing support for patient blood management programs and also require that they justify transfusions to receive funding. It would also put in place a variety of guidelines regarding data collection and availability, among other measures.
Economic models estimate transfusion costs to be around $1,000 to $2,500 per unit of red blood cells, putting the yearly cost for the United States to deliver 12 to 14 million units of red blood cells around $120 to $140 billion. Those estimates do not include the significant costs associated with increased length of hospital stays, infections, or other adverse events.
Dr. Spiess has published research showing that in 11 hospitals performing heart surgery in Virginia, where blood management programs were implemented, blood transfusions dropped by 30%, saving Virginia $49 million over two years. Rates of pneumonia, hospital readmission, and death dropped as well.
Dr. Spiess has also provided input to a patient blood management program in the state of Western Australia, which saved $149 million AUD over two years, dramatically cut transfusion rates in all hospitals, and decreased patient hospital stays by a day and a half from 2008 to 2010. Dr. Spiess is traveling to Australia this month to collaborate on new ways to collect data.
In the immediate term, several steps can be taken without legislation. Dr. Spiess is advocating for Veterans Affairs and military hospitals to serve as a test bed for the regulations and to begin implementing patient blood management and transfusion justifications immediately.
Moreover, initiatives to treat anemia before elective surgery, which is not done at 90% of U.S. hospitals despite the fact that 40% of the public is anemic, would go a long way to improving patient outcomes.
To that end, UF’s patient blood management program plans to open a preoperative anemia clinic this fall. The clinic will optimize hemoglobin levels in patients before elective surgery.
“It’s important to get patients tuned up prior to surgery and treat anemia prior to going to the OR,” Michael said.
PETGators also has a variety of educational initiatives underway, including a series of six lectures by Dr. Spiess, to educate physicians and providers about the importance of appropriate transfusions.
Other initiatives include the creation of a checklist to standardize practice guidelines, a database to demonstrate patient outcomes, and a list of physicians who provide various surgeries for bloodless surgery patients, such as Jehovah’s Witnesses, who do not accept blood products. That would make UF Health a destination site for this type of care.