Multi-hospital effort across Johns Hopkins system improves care and saves money, investigators said.

A five-year effort across the Johns Hopkins Health System to reduce unnecessary blood transfusions and improve patient care has also resulted in an annual cost savings of more than $2 million, researchers report.

A summary of the blood management program, published September 7 in the journal Anesthesiology, details the development and implementation of the program, which quality improvement experts at Hopkins said can be adopted elsewhere by other health systems.

“Hospitals across the country are merging into health systems in part to realize economies of scale by improving quality,” said Steven Frank, MD, professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine and the paper’s first author.

“Our experience with a patient blood management program shows that it’s feasible to do that,” he adds.

According to the Joint Commission, a nonprofit organization that accredits health care organizations and programs in the United States, blood transfusions are one of the top five most overused procedures, in addition to being the most common procedure performed in U.S. hospitals. Beyond the costly misuse of sometimes scarce blood resources, transfusions may carry side effects and harms, so efforts to reduce their use overall are a patient safety issue.

Initiatives such as Choosing Wisely, which focus on reducing unnecessary tests and procedures and are endorsed by multiple professional societies, have further focused on blood transfusions as a target for reduction.

At the start of the new program, the five adult hospitals that comprise the Johns Hopkins Health System spent nearly $30 million each year for blood, an amount that did not include overhead costs of collection, storage and administrative expenses. Those costs alone can increase the blood costs three- or four-fold, he said.

The new patient blood management (PBM) program was launched in January 2012 at The Johns Hopkins Hospital, the system’s flagship institution, with a clinical education program.

The educational outreach consisted of live, in-person Grand Rounds presentations to various clinical departments to inform physicians, nurses and others about hospital transfusion policy guidelines and the results of eight published landmark studies that support reduced use of transfusions.

The network was composed of clinicians from multiple disciplines across all five hospitals, ranging from surgery to obstetrics/gynecology. After the educational campaign was rolled out, a series of well-designed pop-up alerts was launched at all five hospitals to encourage guideline compliance.

The single most effective intervention, said Frank, was the “Why give 2 when 1 will do?” campaign to encourage single-unit transfusions, which resulted in a 49 percent decrease in multiunit orders. The number of red blood cell units transfused per 1,000 patients decreased by 19.8 percent, while plasma transfusions decreased by 38.9 percent and platelets by 15.6 percent.

For the past fiscal year, blood acquisition cost savings were $2,120,273, which marked a 400 percent return on investment for the PBM program, Frank said.