Newly Published
Perioperative Medicine  |   September 2017
Implementing a Health System–wide Patient Blood Management Program with a Clinical Community Approach
Author Notes
  • From the Department of Anesthesiology and Critical Care Medicine (S.M.F., W.W.Y., P.J.P.), Department of Medicine (R.N.T., L.C.R.), Department of Pathology, Transfusion Medicine (S.J.P., J.L., T.A.F., P.M.N.), Armstrong Institute for Patient Safety and Quality (K.H.K.L., T.L.W., P.A.W., R.D., P.J.P.), and Department of Otolaryngology Head and Neck Surgery (L.E.I.), The Johns Hopkins Medical Institutions, Baltimore, Maryland.
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication December 26, 2016. Accepted for publication June 29, 2017.
    Submitted for publication December 26, 2016. Accepted for publication June 29, 2017.×
  • Acknowledgments: The authors would like to acknowledge both financial and personnel support from the Johns Hopkins Health System Armstrong Institute for Patient Safety and Quality (Baltimore, Maryland). They would also like to thank Claire F. Levine, M.S., E.L.S. (Scientific Editor, Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland), for editorial assistance.
    Acknowledgments: The authors would like to acknowledge both financial and personnel support from the Johns Hopkins Health System Armstrong Institute for Patient Safety and Quality (Baltimore, Maryland). They would also like to thank Claire F. Levine, M.S., E.L.S. (Scientific Editor, Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland), for editorial assistance.×
  • Research Support: Support was provided solely from institutional and/or departmental sources.
    Research Support: Support was provided solely from institutional and/or departmental sources.×
  • Competing Interests: Dr. Frank has received consulting fees from Haemonetics (Braintree, Massachusetts), Medtronic (Minneapolis, Minnesota), and Zimmer/Biomet (Warsaw, Indiana). All other authors declare no competing interests.
    Competing Interests: Dr. Frank has received consulting fees from Haemonetics (Braintree, Massachusetts), Medtronic (Minneapolis, Minnesota), and Zimmer/Biomet (Warsaw, Indiana). All other authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Frank: Department of Anesthesiology, Johns Hopkins Hospital, Sheik Zayed Tower 6208, 1800 Orleans Street, Baltimore, Maryland 21287. sfrank3@jhmi.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Coagulation and Transfusion / Patient Safety / Quality Improvement
Perioperative Medicine   |   September 2017
Implementing a Health System–wide Patient Blood Management Program with a Clinical Community Approach
Anesthesiology Newly Published on September 7, 2017. doi:10.1097/ALN.0000000000001851
Anesthesiology Newly Published on September 7, 2017. doi:10.1097/ALN.0000000000001851
Abstract

Background: Patient blood management programs are gaining popularity as quality improvement and patient safety initiatives, but methods for implementing such programs across multihospital health systems are not well understood. Having recently incorporated a patient blood management program across our health system using a clinical community approach, we describe our methods and results.

Methods: We formed the Johns Hopkins Health System blood management clinical community to reduce transfusion overuse across five hospitals. This physician-led, multidisciplinary, collaborative, quality-improvement team (the clinical community) worked to implement best practices for patient blood management, which we describe in detail. Changes in blood utilization and blood acquisition costs were compared for the pre– and post–patient blood management time periods.

Results: Across the health system, multiunit erythrocyte transfusion orders decreased from 39.7 to 20.2% (by 49%; P < 0.0001). The percentage of patients transfused decreased for erythrocytes from 11.3 to 10.4%, for plasma from 2.9 to 2.2%, and for platelets from 3.1 to 2.7%, (P < 0.0001 for all three). The number of units transfused per 1,000 patients decreased for erythrocytes from 455 to 365 (by 19.8%; P < 0.0001), for plasma from 175 to 107 (by 38.9%; P = 0.0002), and for platelets from 167 to 141 (by 15.6%; P = 0.04). Blood acquisition cost savings were $2,120,273/yr, an approximate 400% return on investment for our patient blood management efforts.

Conclusions: Implementing a health system-wide patient blood management program by using a clinical community approach substantially reduced blood utilization and blood acquisition costs.