A Newer, Safer Approach to Managing Patients’ Blood

Not long ago, blood transfusions and blood product usage were almost as common in hospital settings as stethoscopes and scrubs.

“There were automatic daily labs just because the sun rises,” says Warren Behr, director of the Patient Blood Management Program at Lehigh Valley Health Network (LVHN).

“Performing frequent blood tests increases the risk of anemia in hospitalized patients and leads to an increased need for blood transfusions."

But the science around blood management and blood transfusions has changed.

“Clinical evidence over the last 20, 30 years shows us that when we transfuse our patients, they're at an increased risk for infections, transfusion reactions and fluid overload,” Behr says, “whereas the benefit doesn’t always immediately present itself.”

Between this new data and the nationwide blood shortage that is affecting providers locally, it’s clear that a different approach was needed. 

In 2018, Amy Slenker, MD, Vice Chair for Quality and Patient Safety for the Department of Medicine at LVHN had been keeping an eye on the scientific revolution in blood management.

She started a multidisciplinary group at LVHN to map out a strategy for implementing and sustaining leading edge blood management practices across the network.

The group evolved into the Patient Blood Management Program and recruited Behr as director.

“We orient this around the patient,” Behr says about the program. “That’s why we call it patient blood management.”

Individuals who are Jehovah’s Witnesses, for example, have faith-based reasons for declining blood transfusions. And people with anemia may not be good medical candidates for transfusions.

To ensure that LVHN providers are centering these new blood practices in their individualized patient care, Slenker helped build an electronic dashboard that offers guidance, statistics and simple nudges. The system requires a clinical reason for red blood cell transfusion, for instance, and its default number of units is set to one.

“That dashboard is really awesome,” Behr says. “It fits into our total approach of limiting avoidable and unnecessary transfusions.”

LVHN uses a number of techniques to conserve blood during so-called bloodless surgery procedures, including the use of cell salvage technology, hemodilution and medications that can increase red blood cell counts or improve clotting.

Every year, the Patient Blood Management Program impacts more and more individuals. See the charts to observe the growth of the program and its practices over time.

The bottom line from these charts: More people are receiving better and more compassionate care at LVHN. And the Patient Blood Management Program isn’t done yet.

“The future is bright,” Slenker says. “We’ve been super successful, but we still have room to grow.”