Initial work by the WA Patient Blood Management project team showed that there was no routine system in WA allowing the reporting of where and why blood was used and the clinical outcomes of its use.
Research Fellow Aqif Mukhtar, of Curtin’s Centre for Population for Health Research, said without a mechanism in place to track and regulate the way blood was used, incidences of inappropriate blood transfusions could regularly go unchecked, wasting a precious health resource.
“We found that during 2010, 17 per cent of total transfusions in all WA Metropolitan Public Hospitals were inappropriate according to NHMRC guidelines,” Mr Mukhtar said.
National Health and Medical Research Council (NHMRC) guidelines regarding the use of blood state that a transfusion carried out on a patient with a haemoglobin (Hb) count of over 70g/L is inappropriate unless the patient is unstable and actively bleeding. Normal haemoglobin levels for adult males range from 130 to 180 grams per litre for men and approximately 120 to 160 grams for women
“Not only are inappropriate transfusions potentially dangerous, they are also costly,” Mr Mukhtar said.
“If we multiply 4,050 inappropriate transfusions with an average of two Red Blood Cell (RBC) units per transfusion, this amounts to 8,100 inappropriate RBC units.
“With a direct cost of $350 per RBC unit, this represents an expenditure of $2.835 million that could have been saved.”
During 2009, the team set up a concept model of a PBM data system and evaluated the outcomes of a PBM intervention at Fremantle Hospital.
Mr Mukhtar said there were three main objectives in the model; to decrease the incidence of inappropriate transfusions to patients – particularly patients with a Hb above 100g/L; implement single unit transfusion instead of multiple unit transfusion; and develop an electronic PBM database to assemble data on current patterns of blood to use at the pilot hospitals.
Single unit policy is based on the concept that in stable patients, doctors should start with a single unit transfusion and then assess the necessity of subsequent units.
“As a result of the PBM intervention at Fremantle Hospital, the proportion of single RBC unit use has gone up from 18 per cent to 26 per cent,” he said.
“Despite an 8 per cent increase in the patient activity, there was a 5 per cent reduction in the RBC usage during the intervention period.
“During 2010, only 12 per cent of transfusions at Fremantle Hospital were inappropriate compared with an average of 17 per cent across all the WA metropolitan public hospitals.”
Following the success of the pilot scheme at Fremantle Hospital, plans are being developed to include all WA state hospitals, the strategy to better utilise limited blood resources, improve patient outcomes and reduce costs.
Aqif Mukhtar, Research Fellow, CHIRI – Population Health Research, Curtin University
Tel: 08 9266 1851, Email: Aqif.Mukhtar@curtin.edu.au