Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: A retrospective observational study in four major adult tertiary-care hospitals

Michael F. Leahy, Axel Hofmann, Simon Towler, Kevin M. Trentino, Sally A. Burrows, Stuart G. Swain, Jeffrey Hamdorf, Trudi Gallagher, Audrey Koay, Gary C. Geelhoed, Shannon L. Farmer

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Abstract

BACKGROUND: Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes. STUDY DESIGN AND METHODS: This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications. RESULTS: Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p<0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity-based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p<0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p=0.001). Single-unit RBC transfusions increased from 33.3% to 63.7% (p<0.001). There were risk-adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67-0.77; p<0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84-0.87; p<0.001), hospital-acquired infections (OR, 0.79; 95% CI, 0.73-0.86; p<0.001), and acute myocardial infarction-stroke (OR, 0.69; 95% CI, 0.58-0.82; p<0.001). All-cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02-1.10; p=0.001). CONCLUSION: Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings.

Original languageEnglish
Pages (from-to)1347-1358
JournalTransfusion
Volume57
Issue number6
DOIs
Publication statusPublished - Jun 2017

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Tertiary Healthcare
Tertiary Care Centers
Observational Studies
Retrospective Studies
Costs and Cost Analysis
Health
Confidence Intervals
Odds Ratio
Erythrocyte Transfusion
Hospital Mortality
Length of Stay
Hemoglobins
Emergencies
Blood Platelets
Western Australia
Cost Savings
Risk Reduction Behavior
Cross Infection
Erythrocytes
Stroke

Cite this

@article{8be540a7fe6d4b20b1c71293f63bd766,
title = "Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: A retrospective observational study in four major adult tertiary-care hospitals",
abstract = "BACKGROUND: Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes. STUDY DESIGN AND METHODS: This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications. RESULTS: Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41{\%} (p<0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity-based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p<0.001), and anemic elective surgery admissions decreased 20.8{\%} to 14.4{\%} (p=0.001). Single-unit RBC transfusions increased from 33.3{\%} to 63.7{\%} (p<0.001). There were risk-adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95{\%} confidence interval [CI], 0.67-0.77; p<0.001), length of stay (incidence rate ratio, 0.85; 95{\%} CI, 0.84-0.87; p<0.001), hospital-acquired infections (OR, 0.79; 95{\%} CI, 0.73-0.86; p<0.001), and acute myocardial infarction-stroke (OR, 0.69; 95{\%} CI, 0.58-0.82; p<0.001). All-cause emergency readmissions increased (OR, 1.06; 95{\%} CI, 1.02-1.10; p=0.001). CONCLUSION: Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings.",
author = "Leahy, {Michael F.} and Axel Hofmann and Simon Towler and Trentino, {Kevin M.} and Burrows, {Sally A.} and Swain, {Stuart G.} and Jeffrey Hamdorf and Trudi Gallagher and Audrey Koay and Geelhoed, {Gary C.} and Farmer, {Shannon L.}",
year = "2017",
month = "6",
doi = "10.1111/trf.14006",
language = "English",
volume = "57",
pages = "1347--1358",
journal = "Transfusion",
issn = "0041-1132",
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}

Improved outcomes and reduced costs associated with a health-system-wide patient blood management program : A retrospective observational study in four major adult tertiary-care hospitals. / Leahy, Michael F.; Hofmann, Axel; Towler, Simon; Trentino, Kevin M.; Burrows, Sally A.; Swain, Stuart G.; Hamdorf, Jeffrey; Gallagher, Trudi; Koay, Audrey; Geelhoed, Gary C.; Farmer, Shannon L.

In: Transfusion, Vol. 57, No. 6, 06.2017, p. 1347-1358.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Improved outcomes and reduced costs associated with a health-system-wide patient blood management program

T2 - A retrospective observational study in four major adult tertiary-care hospitals

AU - Leahy, Michael F.

AU - Hofmann, Axel

AU - Towler, Simon

AU - Trentino, Kevin M.

AU - Burrows, Sally A.

AU - Swain, Stuart G.

AU - Hamdorf, Jeffrey

AU - Gallagher, Trudi

AU - Koay, Audrey

AU - Geelhoed, Gary C.

AU - Farmer, Shannon L.

PY - 2017/6

Y1 - 2017/6

N2 - BACKGROUND: Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes. STUDY DESIGN AND METHODS: This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications. RESULTS: Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p<0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity-based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p<0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p=0.001). Single-unit RBC transfusions increased from 33.3% to 63.7% (p<0.001). There were risk-adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67-0.77; p<0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84-0.87; p<0.001), hospital-acquired infections (OR, 0.79; 95% CI, 0.73-0.86; p<0.001), and acute myocardial infarction-stroke (OR, 0.69; 95% CI, 0.58-0.82; p<0.001). All-cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02-1.10; p=0.001). CONCLUSION: Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings.

AB - BACKGROUND: Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes. STUDY DESIGN AND METHODS: This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications. RESULTS: Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p<0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity-based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p<0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p=0.001). Single-unit RBC transfusions increased from 33.3% to 63.7% (p<0.001). There were risk-adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67-0.77; p<0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84-0.87; p<0.001), hospital-acquired infections (OR, 0.79; 95% CI, 0.73-0.86; p<0.001), and acute myocardial infarction-stroke (OR, 0.69; 95% CI, 0.58-0.82; p<0.001). All-cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02-1.10; p=0.001). CONCLUSION: Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings.

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U2 - 10.1111/trf.14006

DO - 10.1111/trf.14006

M3 - Article

VL - 57

SP - 1347

EP - 1358

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 6

ER -