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Challenge 3: Transfusion Overuse

    Red blood cell (RBC) transfusion is the most frequent procedure performed in U.S. hospitals, with one in ten inpatients receiving one or more units.1 RBC transfusions rates or practices are highly variable by institution, procedure, and physician.2 Evidence from observational studies shows RBC transfusions can increase mortality by 69% and morbidity by 88%, while restrictive transfusion practices have been proven safe in multiple randomized controlled trials.3,4

    Blood transfusions are costly – between $522 and $1,183 per unit – not accounting for morbidity costs.5 Many transfusions are unnecessary – a systematic review of 494 studies show that 59% are “inappropriate.”6 There is a growing recognition of the need to implement strategies to reduce transfusions by groups such as The Joint Commission and the American Medical Association, with RBC transfusions recently identified as one of the top five procedures that are overused.7,8 In spite of the strong need to reduce RBC transfusions, existing tools for transfusion decision making are limited and may contribute to inappropriate transfusions. For example, estimated blood loss is commonly much more than actual blood loss and laboratory hemoglobin values are only available intermittently and are often delayed. It is estimated that the use of technology to reduce RBC transfusions can save the U.S. healthcare system up to five billion dollars per year, while significantly improving quality and safety.9

    At the Patient Safety, Science & Technology Summit, an expert panel will review a variety of approaches that are available immediately for hospitals committed to reducing unnecessary RBC transfusions, including pre-operative screening, continuous monitoring, and decision support. The panel will also explore the potential impact of medical device interoperability and information sharing for improving RBC transfusion assessgments.

    1. AHRQ. Inpatient Sample. 1997-2007.
    2. Frank S et al. Anesthesiology. 2012. 117(1): 99-106.
    3. Marik Crit Care Med. 2008;36(9):2667-74.
    4. Carson et al. Cochrane Database Syst Rev. 2012 Apr 18;4:CD002042.
    5. Shander A et al. Transfusion. 2010;50(4):753-765.
    6. Shander et al. TransMed Rev. 2011. 232-246.
    8. Joint Commission Perspectives. The Joint Commission Continues to Study Overuse Issues. Volume 32, Number 5, 2012: 4-8(5).
    9. Masimo Corporation Estimate. November 2012.