Blood Management via a consulting group

[catmontgomery]

Has any one invested in an outside blood management group for their hospital? This appears to be a hospital initiative to obtain help from an outside organization to help with cost cutting measures and increase safety.

Our hospital is looking at a consulting group to help with blood management. This includes educating physicians and nurses about appropriate use, suggesting/setting up guidelines for product use for surgery and routine anemic/blood loss situations. As the hospital looks for ways of cutting costs, they are looking at a group which will help decrease blood usage, patient length of stay, increase patient safety,and cut costs 30%-50%. Our hospital Quality Management department would oversee the process if this group is contracted.

Currently we have a Pharmacy and Transfusion committee which meets every two months and the sub-committee/transfusion committee meeting quarterly to twice a year. We have guidelines for transfusion triggers that are considered liberal (8 hgb for blood, plts given for varying situations from 10,000 to 50,000, etc) with review of non-compliant physicians as needed.

As one of those blood bank supervisors who works on the bench occasionally along with the usual blood bank quality management, technical supervisor,blood bank computer tech, blood bank support for nursing, reviewer of our contracted perfusionsists cell saver use, etc without additional help, my reports are general in nature and not in depth as needed due to time constraints.

Any suggestions for questions to bring up at an upcoming meeting to discuss hiring this group. The management group is suggested by our buying group affiliates. Lab manager sees potential in cutting costs in blood product usage. Our Laboratory Medical Director sees scenarios where blood product availability would be limited and patients at risk.

Thank you for any suggestions or comments.

Cat

[Mabel Adams]

I would want some references for the consulting group to see if they consistently get these great results. Hopefully someone on here that has hired them will respond. I would want to explore how they might approach educating nurses and physicians to make sure it will "fit" with the local culture. Beyond that, if the organization wants to hire someone to do the hard job of teaching everyone in the organization the new guidelines I'd be inclined to let them. Just be sure it won't be your fault if the results aren't as good as promised.

[Likewine99]

Our organization was extremely successful with a blood conservation project but we did it ourselves. We had buy in from the CMO which is of the utmost importance. Docs will listen to other docs.

We had input from the financial side, the Blood Bank sups, lab directors, pathologists and representatives from our blood supplier, people from the quality and risk dept. If you have a strong physician leader internally you may be better off w/o the consultants.

Mabel is absolutely correct, get references, talk to their clients, make sure that the dollars that were saved were "real dollars" and not just some smoke and mirror financial mumbo jumbo.

[David Saikin]

Make sure your potential savings are enough to pay the consultants. . . you could actually lose money. I think you would be better off implementing your own cost saving measures . . . you need a doc to sell this to your staff.

I had an Ortho guy who transfused at hgb of 10 . . . we tried everything we could to get him to be more conservative but that was/is the way he does thing. Finally, after much browbeating, journal articles and peer comparisons he now hardly transfuses at all (I mean he would transfuse 20u/month, now he does an average of 4).

Edited March 8, 2013 by David Saikin

[L106]

I echo the good suggesting by Mabel, Mary, & David. We talked to such a consulting firm several years ago, and their fees/costs seemed really high. Our hospital ended up implementing its own blood conservation methods & we have seen significant success (although I'm sure we were not as aggressive as the consulting firm would have been.) Unfortunately, I don't have any hard data or cost analysis to offer.

I would also be very interested to hear from some posters who have used such a consulting firm.

Donna

Edited March 8, 2013 by L106

[catmontgomery]

Thank you for your review and suggestions. We had a strong Transfusion Committee which did keep the blood bank usage in good order, the MDs up on education and process until half of the committee MDs retired within the past couple years. During our meeting today, it was agreed to have the free consultation from the group and review the findings.

[THannonMD]

Cat and group-

I am an anesthesiologist that has been involved in implementing blood management programs for 20 years, I am past president of the Indiana State Association of Blood Banks, I am on the MAC for the Indiana Blood Center, and I am on the AABB Perioperative Standards Committee. I try as I can to post info on discussion boards like this and on LinkedIn.

In full disclosure, I established a consulting group 7 years ago that develops and helps continuously improve comprehensive blood management programs (Strategic Healthcare Group). I didn't go to medical school to be a consultant, but I was continually asked by hospitals to help them with the difficult task of changing embedded behaviors and cultures among doctors and nurses, then making the change stick. My team is front line doctors and nurses with significant blood management experience, and our approach is evidence based, patient centered, data driven and systems oriented. As an MD, I am extremely proud that what we do rapidly and sustainably improves patient safety and quality of care; as a business owner, I am also very proud that what we do rapidly and measurably returns value with a substantial ROI.

For those hospitals who prefer to build their own program, we have a world class set of online tools as well as training and support program for TSOs and program leaders. The tool set include access to our proprietary Analytics to benchmark and track blood use compared to centers of excellence (a true benchmark, not just an average), a knowledge management system with a repository of articles, policies, guidelines and best practices, and a learning management system that includes 24 hours of live CME Webinars a year, 60 hours of online training, and a train the trainer program at our HQ in Indianapolis.

With regards to client references, we strive to make every hospital fully satisfied and we garner superlative recommendations. We have worked with over 100 hospitals and hospital systems across the US, both academic and community, from 150 beds to 1000 beds.

I apologize for the commercial message, but I take great pride in what we do and would be very pleased to work with any of your hospitals to improve transfusion safety and blood management. If you would like more information, you can reach out to me directly at thannonmd@gmail.com, or check out our web site www. BloodManagement.com, which has quite a bit of information as well as case studies.

Best regards,

Tim Hannon, MD

[Malcolm Needs ☆]

Tim, thanks for that.

I believe that, whilst there are genuine people like you around, there are, however, also individuals and companies that call themselves "consultants" in the world of blood transfusion and other areas, where there is no history of them ever having worked within the area being examined before, and from whom there is the distinct smell of snake oil and the detritus from the rear end of bulls!

[carolyn swickard]

Blood Systems Inc - (also know as United Blood Sevices) has a Blood Management program they are offering to hospitals also. If you happen to be one of their hospitals, they can help with startup and maintenence - but it is expensive. Also - even with the data from their program, you are going nowhere without a strong physician advocate and training/monitoring program pushed by Administration. Once Administration sees the monetary figures involved in Blood Management programs, they are excited - but if they expect the Blood Bank team to enforce the "expected rules/ranges" without a lot of support, your team is in for a miserable time.

[Mabel Adams]

Fortunately the concepts of blood management have been published in more than just Transfusion Medicine journals so intensivists and anesthesiologists are likely to have heard of it and may be ready to champion it. There is a weekly newsletter on the topic from Dr. Hannon's website that cites new articles that come out relating to the topic. It's free and interesting. We have used some of the other materials from the site to start our education process.

[aafrin]

I had an Ortho guy who transfused at hgb of 10 . . . we tried everything we could to get him to be more conservative but that was/is the way he does thing. Finally, after much browbeating, journal articles and peer comparisons he now hardly transfuses at all (I mean he would transfuse 20u/month, now he does an average of 4).

We had a new cardiothoracic surgeon join us a few months back who wanted whole blood for CABGs and cancelled the surgery since we do not issue whole blood. Refused to take PRCs, FFP & PLts as required. Fortunately our medical Director convinced/cajoled him after showing him peer reviews and articles from journals. Now he uses the components without much murmur, but I have heard that at another hospital where he operates they keep whole blood only for his surgeries.

[THannonMD]

I think everyone agrees that tools are necessary but not sufficient- you also have to find physician and nursing champions to own the process. Blood utilization improvement is not a lab issue- it is a clinical issue. Just remember- the only way to get a surgeon to do something is to make him think he came up with the idea!

-Tim