Regions Hospital, St. Paul, Minn., has cut the average amount of blood transfused  by 94 units per month, or 14 percent, since 2011.

With the American Red Cross, Regions Hospital’s pathology department developed a decision-support tool for its electronic medical record. The tool is designed to improve the appropriate use of red blood cells based on the latest evidence-based clinical guidelines.

“We are successfully changing the thinking behind transfusions,” said Amar Subramanian, M.D., an informatics pathologist at Regions Hospital. “A blood transfusion is like a liquid transplant, and even under ideal conditions, it’s not as good as someone’s own blood.”

As part of this work, Regions Hospital reduced the point at which doctors initiate a transfusion, called the hemoglobin trigger, to less than 7 g/dl in stable patients. The decision-support tool automatically alerts physicians if a patient’s most recent hemoglobin levels are above that and also cautions against administering more than one unit of blood at a time.

A 2012 Premier healthcare alliance analysis of blood use at 464 hospitals determined that if all hospitals adopted these evidence-based best practices for use, it could save the health care system more than 802,000 units of blood and $165 million in costs without a decline in patient outcomes.


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