$6 million annual savings over 1,100 cases
”Whether you like it or not, you will have to institute a blood management program,“
declared David Fitzgerald, CCP, at the beginning of his presentation.
Mr. Fitzgerald, Chief of Perfusion at INOVA Heart and Vascular Institute, in Fairfax,Virginia, introduced a series of changes to his perfusion protocols in May, 2007 after he made the surprising discovery that 60% of cardiac surgery patients at his institution were receiving a blood transfusion, half of them intraoperatively.
After six months, only 28% of patients were receiving a transfusion. In addition, he documented other clinical benefits, including significant reductions in expected length of stay, re-operations for bleeding, and prolonged ventilator times.
He presented his calculation of associated cost savings: the new protocols are saving the institution nearly $6 million in annual savings over 1,100 patients:
$2.2 million direct savings on blood used intraoperatively
$2.0 million direct savings on blood used post–operatively
$1.5 million savings from not using aprotinin
Mr. Fitzgerald also reviewed a compelling body of literature that describes patient risks associated with blood transfusions.
$1.3 million to $2 million annual savings over 420 cases
”The cost to acquire blood has more than doubled since 1998,“ according to Joe Basha, CCP, Perfusion International, LLC, in Alexandria, Louisiana. ”And the hospital is forced to absorb the increases.“
Mr. Basha provided a summary of the factors responsible for the rising cost of banked blood, including increased testing and blood shortages. He expects that cost to double in the next five years.
He continued by citing studies that calculate the cost of the blood product itself is only 20% of the total cost transfusion cost; after adding the use of resources to test and administer the transfusion and the adverse patient effects it generates, the actual cost of a transfusion is $1,600 – $2,400 per unit.
Mr. Basha subsequently implemented several new procedures and sharply reduced the prime volume of his perfusion circuit, from 2300mL to 735mL. The measures have reduced the average transfusion rate in his program from 7.6 units per patient to less than one. However, he expects the transfusion rate will rise to 3.8 units per patient when the hospital is forced to stop using aprotinin.
He calculates that by saving only 2 units of blood per patient over 420 patients, the hospital is saving between $1.3 and $2 million dollars annually (using the most conservative and most liberal cost calculations) as a result of the blood management practices.
$80,000 annual savings over 450 cases
Jim Patterson, CCP, described how the perfusion team at Excela Health’s Westmoreland Hospital in Greensburg, Pennsylvania switched from a 4:1 cardioplegia protocol to a microplegia protocol using the Master ⁄ Follower capability of Terumo® Advanced Perfusion System 1. The change resulted in an annual savings of $80,000 on 450 cardiac surgery cases at the hospital. The financial analysis, conducted by the hospital’s pharmacy department, compared the costs associated with both protocols, including the cost of the cardioplegia drugs and solutions, insulin use by anesthesia, and pharmacy labor.
The savings do not include the cost of reducing edema, length of stay, or other outcome benefits; Mr. Patterson is beginning to document these outcomes.
The perfusion team also decreased prime volume and instituted other blood management procedures. The result? ”Only one in five of our patients received a blood transfusion last year,“ he claims.
Read more about the cardioplegia protocol at Excela Health’ Westmoreland Hospital.
$63,400 annual savings over 317 cases
It was near the end of the symposium when Brad Kulat, CCP suggested to the audience that ”Reducing a patient’s exposure to banked blood is priceless.“ Mr. Kulat, Coordinator of Perfusion Services at Children’s Memorial Hospital in Chicago, Illinois, began his presentation with the results of his analysis of the composition of banked blood; he found unacceptable levels of lactate, glucose, and potassium, prompting him to recommend washing all packed red blood cells before putting them in the prime.
He and his team created a unique perfusion set up using the remote mounting capabilities of Terumo System 1 that resulted in significant prime volume reduction and a resulting reduction in blood usage, from 45–73% depending on the patient size. The hospital is saving $200 per case on blood products. (Mr. Kulat calculated only the direct costs of the banked blood for intraoperative use.) In 2007, with 317 patients, that amounted to $63,400 savings per year in blood bank costs alone.
More important, according to Mr. Kulat, is the ability to reduce patient exposure to bank blood because of the increased risk from transfusion reactions, pathogen transmission, impairment of the microcirculation, and a decreased survival rate.