Reducing Unnecessary Blood Transfusions

Electronic medical records help The Blood Management Program improve practices and lower costs.

Published in Dome - November/December 2017

Johns Hopkins Medicine saved $2.4 million last year by reducing unnecessary blood transfusions across the health system, thanks to efforts by the system’s Blood Management Program using data acquired from the Epic electronic health records. These results were reported in the November issue of the journal Anesthesiology, where the article describes a 400 percent return on investment for supporting the program.

“Epic has improved our ability to do evidence-based transfusion practice,” says Steven Frank, director of the Johns Hopkins Blood Management Program. “Doing blood management is very data-intensive. We monitor transfusion guideline compliance, and with the right data, you can improve practice by showing providers their compliance rates compared to their peers.”

Using interactive dashboards, Frank and colleagues can easily monitor usage of red blood cells, plasma and platelets by individual departments at all five local hospitals in the health system, even drilling down to see the practice of individual providers. Reports are distributed to hospital departments monthly to encourage improved blood utilization and reduce unnecessary transfusions.

“These reports are essentially audits with feedback, and they work because we emphasize positive feedback for those with excellent compliance rates,” Frank says. “We’ve found that’s the best way to improve practice.”  In addition, when physicians go to order blood products in the Epic system, they see a best practice advisory supported by two landmark studies in the New England Journal of Medicine, with hyperlinks to the articles. “It tells the providers this is not just our opinion; these are rigorous randomized trials supporting that “less is more” in terms of transfusion,” says Frank.

Building on a successful campaign to reduce unnecessary red blood cell use when Epic went live in July 2016, Frank and colleagues added a push to reduce unnecessary platelet transfusions. “Platelets are the highest risk and the highest cost of all the major blood components, so it makes sense to reduce platelet overuse as well,” he says.

“We had our best year ever after all hospitals were up and running on Epic, and we clearly leveraged the power of the Epic system to reduce unnecessary transfusions along with their associated risks and costs,” Frank says. “In addition, we are now finding that clinical outcomes such as morbidity, mortality, length of stay, and readmission rates, are either the same or better, compared to the pre-blood management time period.  This may be the most exciting finding to date.”