UIHC program does more with less


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The University of Iowa Hospitals and Clinic’s Blood Management Program is proving that, when it comes to blood transfusions, more might not always be better.

In its first three years of existence, the program has dropped red blood cell usage by almost 30 percent, according to UIHC officials.

The program, an office of the University of Iowa Hospitals and Clinics, is an evidence-based, multidisciplinary process that focuses on how to best utilize the hospital’s blood resources.

“It gets the right blood to the right people in the right amounts,” said Michael Knudson, medical director of the Blood Bank and Donor Collections.

Since it's inception in 2011, the program has reduced about 450 complications — based on blood transfusion’s 4 percent complication risk — including strokes, heart attacks, hospital acquired infections and organ failure.

Knudson said the UIHC is relatively proactive in tackling blood restriction issues, stating the UI’s Blood Management Program was one of the first of its kind in the country.

“There is still a large number of hospitals that haven’t done anything with blood management,” he said.

Aldijana Avdic, director of the Blood Management Program, hopes to sustain the positive results achieved so far by expanding.

“For the last few years, we have been working on getting clinics going to help treat anemia, and it could go live very soon,” Avdic said.

Avdic also said the program saved 127 lives with transfusions, given a 0.9 percent mortality rate per transfusion.

“Our focus is to reduce how much blood we use so that our supplies can be used more effectively,” Avdic said.  

The program, established in 2011, is part of the Office of Clinical Quality, Safety, and Performance Improvement, which focuses on enabling physicians at UIHC to provide the best care possible for its patients.

“[The office] engages in continuous improvement,” UI spokesman Tom Moore said. “We are interested in anything we can do to improve patient outcomes.”

Knudson said the program was established to analyze, educate and apply several studies with new information on blood transfusion.

“There are a growing number of studies that suggest transfusing people at high thresholds could actually be harmful,” Knudson said.

Although numbers vary from patient to patient, Avdic said blood transfusions are now reserved for patients who have hemoglobin levels of seven grams per deciliter or less, a relatively conservative amount when compared with historical precedents.

“Blood transfusions were originally designed for battlefields, when soldiers would be losing lots of blood very quickly,” Avdic said. “Now, more and more literature suggests the restriction of blood resources.”

This restriction means existing blood resources are used in a way that increases its utility, thereby saving more lives, she said.

“Patient outcomes are improving because of the ‘less is more’ approach,” Knudson said.  

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