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Waste Report Analysis Finds Significant Opportunity in Blood Usage with No Impact on Patient Outcomes

  • Industry-wide standardization is needed to improve outcomes, reduce costs, according to Premier healthcare alliance analysis
  • Treating sepsis, major cardiac surgeries present largest opportunities

CHARLOTTE, N.C.--(BUSINESS WIRE)-- At a time when our national blood supply is at a 15-year low, lack of scientific evidence supporting specific blood utilization practices is leading to wide usage variation in hospitals, according to a new analysis.

In the largest comparative effectiveness analysis of blood product utilization in scope and scale conducted to date, the Premier healthcare alliance found an opportunity for 464 hospitals to save $165 million annually in purchasing costs alone by reducing usage by 802,716 units – while maintaining positive patient outcomes. The opportunity does not include costs associated with blood testing, storage, transportation or administration, or harm to patients due to the administration of unnecessary blood products. These expenses can add hundreds of dollars to unit costs.

Transfusion of blood products is a critical part of clinical care. In the U.S., blood is used every two to three seconds to treat patients with cancer and other serious diseases, for organ transplants and to save the lives of accident and trauma victims. In addition, nationwide:

  • Transfusions save up to 4.5 million Americans each year, or more than 12,000 lives a day.
  • Transfusions are the most commonly billed procedure for hospital patients, with about 15 million performed annually at a cost of $10 to $15 billion.
  • Hospitals and emergency treatment facilities use about 44,000 units of blood daily.
  • Overuse of blood and transfusions can lead to a number of adverse patient outcomes, such as cardiac arrest, higher infection rates and longer length of stay.

According to Premier’s analysis, which appears in Premier’s fall 2012 Economic Outlook, although many clinical practice guidelines for blood product usage exist, scientific evidence supporting specific practice recommendations is not robust. This lack of strong evidence, coupled with differences in patient type and need, often leads to overuse of blood products, and can cause discrepancies in how and when surgeons and anesthesiologists order blood products.

“Every physician is trained to use their best judgment in making treatment decisions. Despite this training the evidence demonstrates that there is significant variation that has little or no value to our patients,” said Marlon Priest, M.D., executive vice president and chief medical officer at Bon Secours Health System (Marriottsville, Md.). “I think we, and many others, have demonstrated that with reliable information physicians can reduce unnecessary variation.”

“Benchmarking against large data sources of both utilization and outcomes provides me the confidence that we can get to optimal blood utilization,” continued Priest. “Without such tools there is no surprise we are seeing broad variation in the use of blood, a lifesaving but precious treatment.”

A Bon Secours campaign to improve outcomes for heart surgery patients while reducing practice variation led to a 65 percent reduction in blood utilization, 14 percent reduction in adverse events, 20 percent reduction in length of stay, and savings of nearly $2 million across five hospitals in just four years. In making these improvements, the system accessed Premier’s database, which contains information on 1 in every 4 patient discharges, 2.5 million real-time clinical transactions a day and $43 billion in annual purchasing data. The information in this comparative de-identified database is severity-adjusted.

Identifying opportunities through comparative effectiveness analysis with large dataset

Premier set out to identify variations in blood product use and potential opportunities for improvement and cost savings. Using MS-DRG case-mix adjusted data from the nation's largest clinical, financial and outcomes database, Premier examined blood use across 7.4 million de-identified discharges from 464 hospitals (April 2011 – March 2012).

Individual hospitals were compared to a benchmark set by the top-performing quartile – those hospitals with lowest utilization of blood products and better than expected patient outcomes. Comparisons took into account patient diagnoses and severity of illness.

The analysis suggests that, considering the variation of blood use presented, hospitals should review their own practices and protocols to identify potential waste while maintaining care quality.

In addition, based on experiences working with member hospitals and national experts, Premier suggests six critical factors for successful blood management.

“It’s well-known that there is opportunity to reduce waste in healthcare. A missing link has been specific data to conduct comparative analysis on the effectiveness of different practices,” said Mike Alkire, chief operating officer at Premier, a provider-owned alliance helping hospitals and other health providers improve their patient care and finances. “Our goal in conducting this analysis is to raise awareness of the economic realities of blood use and encourage providers to think more critically about their usage patterns.”

“We’ll continue to work with our members and industry experts such as the AABB to identify more detailed measures to help provide a road map for blood usage improvements and cost savings while maintaining high-quality care,” Alkire said.

In this analysis, Premier applied its first-of-its-kind “waste report,” which identifies different categories of potential savings opportunities in hospitals. The report, which led to Premier placing third in healthcare on this year’s InformationWeek 500 list of the top technology innovators, analyzes hospitals with opportunities for savings improvement, and is customized by hospital to provide the most actionable information possible. According to the dashboard analysis, blood utilization represents the eighth highest savings opportunity for hospitals – a savings of $1.06 million per hospital, per year.

Additional results

By blood product

Results across all 464 hospitals show that, to treat similar patients, the top performing quartile used fewer units of all blood products, although the largest difference was in the use of red blood cells – 358,617 units and $75.7 million.

By business line

Opportunities at the business-line level indicate that usage variations exist across the inpatient service areas. The largest volume of potential opportunity identified was in internal medicine (196,699 units), followed by cardiac surgery (167,490 units) and general surgery (156,326 units).

By diagnosis

Potential opportunity for reduction in utilization for the top 10 inpatient diagnoses (by Medicare MS-DRGs) suggest that treatment of sepsis presents the highest individual opportunity (35,650 units). This opportunity is based on volume of patients, and the extreme hospital-to-hospital variation indicates a clear need to review standard practice. Five of the remaining diagnoses involve major cardiac surgeries, despite the fact that none has a total inpatient volume in the top 25.

About the Premier healthcare alliance, Malcolm Baldrige National Quality Award recipient

Premier is a performance improvement alliance of more than 2,700 U.S. hospitals and 90,000 other sites using the power of collaboration and technology to lead the transformation to coordinated, high-quality, cost-effective care. Owned by hospitals, health systems and other providers, Premier operates a leading healthcare purchasing network with more than $4 billion in annual savings. Premier also maintains the nation's largest clinical, financial and outcomes database with information on 1 in 4 patient discharges. A world leader in delivering measurable improvements in care, Premier works with the Centers for Medicare & Medicaid Services. Headquartered in Charlotte, N.C., Premier also has an office in Washington. https://www.premierinc.com. Stay connected on Facebook, Twitter and YouTube.

Premier healthcare alliance
Alven Weil, 704-816-5797

Source: Premier healthcare alliance