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Active Blood Management Practices on Labor and Delivery: Using Cost-Analysis to Evaluate Blood Product Utilization
Abstract Number: SAT-26
Abstract Type: Original Research
Introduction: Blood transfusion is one of the most overused procedures in the US. Patient blood management (PBM) programs, including evidence-based transfusion practices and protocols reduce the use of blood products and patient morbidity in postpartum hemorrhage (PPH).[2,3,4] Hospitals have demonstrated cost savings after PBM program implementation. This study analyzes blood utilization and cost-savings on labor and delivery (LD) after implementation of a PBM program and early cryoprecipitate (CRYO) repletion for PPH.
Methods: This IRB-approved retrospective analysis used the electronic database warehouse to identify women who received blood products on LD and the post-partum floor. Two time periods, pre (January 1, 2012 to October 31, 2013) and post-implementation (November 1, 2013 to December 31, 2015) of a PBM program were studied. The PBM program included: PPH protocol + protocol requiring Hgb checks between pRBC units in stable patients. Data was analyzed based on blood product transfusion before and after PBM program implementation. Data was also analyzed based on pRBC utilization with early (prior to or concomitant with pRBC) vs late or no CRYO transfusion. Institutional cost/unit data for blood products was used to determine average costs for the two time periods, and the average cost savings per group per time period were determined. A cost savings equates a decrease in utilization, and a cost increase indicates increased utilization.
Results: 351 patient received transfusions during the 4 yr period. Product type, location, date and order of product transfusion was available for analysis. Utilization of pRBCs, CRYO, platelets and FFP all declined during the study period. Cost analysis of product utilization following the implementation of the PBM strategy is presented in Table 1.
Discussion: This study demonstrates that PBM practices that include a PPH protocol, transfusion protocol (requiring CBC between pRBC units) and early repletion of fibrinogen may reduce the quantity of blood products used and therefore the cost associated with unnecessary transfusion. The estimated cost savings per year at our institution after the implementation of all three methodologies was 23.4%.
1)The Joint Commission 2012; http://www.jointcommission.org/assets/1/6/national_summit_overuse.pdf
2)Shields et al. AJOG 2015;212:272-80.
3)Levy et al. Transfusion 2014;54:1389-1405
4)Levy et al. Blood 2015;125:1387-93
5)Thakker et al. Transfusion 2016;56:2212–20