Advocate Health Care blood transfusion initiative saves millions

You can't draw blood from a stone, the old saying goes. But you can from a hospital--and apparently save barrels of money by doing so.

That's what Rishi Sikka, M.D., vice president of clinical transformation for Advocate Health Care, the Illinois-based hospital system, recently told me in an exclusive interview.

According to Sikka, the clinical setting overuses blood. And it's a habit that's ingrained in physicians early and often.

"The way I was trained, you always give blood in even units," said Sikka, who received his medical education at the Mayo Clinic in Rochester, Minn. but did his undergraduate work at The Wharton School of the University of Pennsylvania. The problem is, if patients only need one unit, it's a waste. And if they really require no blood at all, it's putting them at risk of an adverse outcome.

"Blood is like a liquid transplant. And anytime you give blood, you have all the same risks of any other kind of transplant," Sikka said. That includes infections or an allergic reaction. And there's also the risk of a patient receiving too much blood, creating a condition known as volume overload, which can lead to pulmonary edema and other serious health issues.

Not long after Sikka was named to his current position in 2011, he decided to embark on an initiative to reduce blood usage. The organization retained an outside consultant and sought buy-in from the medical staff. To marshal support, the organization relied on videos and other promotional material, such as internal slogans. Among those slogans was the popular "one is the new two." According to Sikka, "that became quite catchy."

Advocate Health Care gradually implemented a variety of changes, including the use of smaller vials to draw blood (patients can actually suffer from anemia during a hospital stay as a result of regular draws), and the use of electronic medical records to monitor physicians and track their compliance with ordering fewer units for transfusions. It also made changes in the operating suites to cut down on the use of blood.

This was not bloodless medicine, a fairly radical approach offered by Southern California hospitals in the 1990s to service a sizable population of Jehovah's Witnesses, who don't believe in transfusions. Instead, Advocate Health Care encouraged the use of drugs, such as tranexamic acid, which improves clotting and cuts down on the need for transfusions during highly vascular procedures, such as hip replacements.

A handful of other hospitals scattered thorughout the U.S. have also successfully adopted the approach.

As a result, Sikka estimates as of late last year that Advocate's 11 hospitals used 39,269 fewer units of red blood cell transfusions since it officially implemented the program in the spring of 2012. The program has resulted in 663 fewer patient complications, reduced patient stays by 24,480 days, cut nursing time by 36,000 hours and saved as many as 149 lives, he saiid..

In addition to improved outcomes, costs are also down, according to Sikka. He estimates the program has saved Advocate $8.5 million so far.

"In this era of value-based reimbursement, it is a real value play both on quality and efficiency," Sikka said. And both the clinical and financial numbers should draw the attention of any hospital executive. - Ron (@FierceHealth)

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