Background: Multiple studies support the association between systematic implementation of Patient Blood Management (PBM) programs and improved patient outcomes, reduced RBC utilization, and decreased healthcare costs. In 2019, Sentara Healthcare launched a system-wide PBM program aimed at decreasing avoidable transfusions by 24% over 3 yrs. Several care collaboratives, including the Society of Hospital Medicine (SHM), have recognized PBM as part of their Choosing Wisely® campaigns. Approximately 75% of all inpatient care is managed by hospital medicine (HM) physicians, making them uniquely positioned to influence transfusion practice, improve outcomes, and reduce organizational costs. Recognizing this, the Sentara Medical Group (SMG) HM team developed a change management strategy to engage providers that leveraged organized PBM program implementation, Choosing Wisely®, and personal goals to transform their transfusion practice.
Methods: In partnership with PBM experts, a system-wide, comprehensive PBM program was initiated across Sentara Healthcare. Program implementation included: development of a multidisciplinary system steering committee; adaptation of order sets to reflect up-to-date, evidence-based (EB) clinical guidelines; distribution of actionable system, hospital, and specialty provider level performance data to clinical leadership; and widespread education/awareness resources for providers focused on lowering hemoglobin thresholds and single unit transfusion (SUT). Data identified SMG HM as the system’s top transfusing specialty. Along with program implementation, SMG HM leaders asked that each site team commit to HM Choosing Wisely® transfusion recommendations as an annual quality goal to maximize their impact on PBM program success. A portion of SMG HM’s quality bonus was tied to committing to understand recommendations, practice EB standards, and strive to achieve metric goals.
Results: By implementing the methods outlined, the SMG HM team not only exceeded year-1 system metric goals but were also performing above the 90th percentile (based on national database benchmarks) in just 12 months. As of Q3 2021, SMG HM has increased rates of SUT by 42% and transfusions at Hgb < 7 mg/dL by 62%, decreased transfusions at Hgb > 8 mg/dL by 85 %, and reduced provider practice variation. These improvements resulted in 3129 fewer RBC transfusions (volume adjusted, 38% overall reduction) and decreased blood acquisition costs ($588K). Estimated indirect impact of SMG HM efforts include potential complications (125) and deaths (28) avoided, LOS reduced (4694), nursing hours saved/reallocated (6884), and activity-based RBC cost savings ($2.3M).
Conclusions: Employing a systematic approach to PBM program implementation that includes a solid infrastructure, EB guidelines, meaningful data, ongoing clinical conversation, and education on current evidence in combination with personal provider goals can be powerful catalysts to transform RBC transfusion practices. Such advancements reduce blood utilization, lower organizational costs, and minimize patient exposure to risk resulting in better patient outcomes.
