Saving blood saves money, lives

Cross-specialty collaboration boosts cardiac surgery results

Patients undergoing cardiac surgery may receive blood transfusions to make up for loss of blood. The transfusion rate – the percentage of cardiac surgery patients who receive blood during surgery – varies a great deal nationwide, from 7 percent to 90 percent.

At the University of Vermont Medical Center, a multidisciplinary cardiac team – with members from Cardiothoracic Surgery, Anesthesia, Nephrology, Perfusion, the Jeffords Institute for Quality and the Blood Bank – set out to lower the transfusion rate. They started with small changes; over four years they changed the culture surrounding transfusion, making care safer while saving money.

Everybody who impacts the cardiac patient has a role in this. It is an important team effort.

Charlie Krumholz, chief perfusionist

The group developed practice guidelines, treatment protocols and a special postoperative transfusion procedure. Thanks to many efforts, the hospital reduced blood transfusion rates during cardiac operations to 25 percent in 2014. Since then, UVM Medical Center has reduced that transfusion rate to 10 percent, one of the lowest in the country.

By changing transfusion practices, in 2015 UVM Medical Center cut the overall patient mortality rate for cardiac surgery in half, to 1.4 percent in 2015; lowered the rate of acute kidney injury by 25 percent to 2.8 percent; reduced mediastinitis infections (an inflammation of the tissues in the mid-chest) to 0.2 percent (from 0.7 percent in 2012); and saved more than $150,000 in blood products.

The hospital is now a leader in this effort, says Chief Perfusionist Charles Krumholz. With lower transfusion rates, Krumholz says, “Our mortality is lower and patients feel better.”

These changes do not increase cost, but do require willingness by a large team to change long-held practices. “We’re working to change the culture of transfusion,” Krumholz said. “Everybody who impacts the cardiac patient has a role in this. It is an important team effort.”