Reducing Blood Product Use Through Reflexive Testing [Utilization Spotlight]
Since 2012, we have been publishing a Utilization Spotlight in every issue of the Communiqué. Each Spotlight offers a quick view of utilization management best practices in action. This Spotlight is from September 2015.
In an effort to reduce blood product utilization and testing in clinical hematology, Mayo Medical Laboratories proposed a test utilization project to change the way blood type and antibody screen testing are used for hematology outpatients undergoing chemotherapy who are being considered for red blood cell transfusion.
In an effort to reduce blood product utilization and testing in clinical hematology, we proposed a test utilization project to change the way blood type and antibody screen testing are used for hematology outpatients (undergoing chemotherapy) who are being considered for red blood cell (RBC) transfusion. These patients come in twice weekly for monitoring. Our current state is that the blood type and antibody screen are ordered, collected, and performed concurrently with the complete blood count (CBC). While this approach is patient centric, it is a costly option. Based on a retrospective review of our data, we found that less than 20 percent of type and screen tests in this situation actually result in RBC transfusions.
With that knowledge, we proposed creating a reflex test in which the blood type and antibody screen testing is based on the CBC result. Specifically, if the hemoglobin is greater than or equal to 8.0 g/dL, the blood type and antibody screen would not be done. However, if the hemoglobin is less than 8.0 g/dL, the blood type and antibody screen would be performed using the CBC specimen, thus eliminating any additional blood collection and inconvenience for the patient.
Using retrospective data review, we estimate that this approach could result in the following savings without adding incremental resources:
- Decreased number of blood type and antibody screen tests: 10,949 versus 1,812
- Reduction in phlebotomy blood volume: 76.6 liters
- Estimated total cost savings: $1,467,139 versus $242,208
In summary, by allowing the CBC hemoglobin result to drive whether a blood type and antibody screen for possible transfusion is performed, the hospital and laboratory will eliminate unnecessary testing and blood draws, thus saving cost and improving patient care.