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Patient Blood Management Key for Accountable Care Organizations

Beth H. Shaz, MD; Christopher D. Hillyer, MD; Jonathan H. Waters, MD
JAMA Surg. 2013;148(6):491-492. doi:10.1001/jamasurg.2013.69.
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Blood products and their transfusion represent significant expense to hospitals. As health care systems look toward more affordable, higher-quality care, better management of our blood supply offers significant opportunity to contribute to these goals. Audits have demonstrated that 15% to 30% of blood products are used outside of evidence-based guidelines.1 A recent JAMA article2 demonstrated hospital variability in blood use in adult cardiac surgery; rates of transfusion ranged from 7.8% to 92.8% for red cells, 0% to 97.5% for plasma, and 0.4% to 90.4% for platelets. This high variability reflects the variability that exists in health care overall, for instance, variability in surgical approach to total hip replacement (1-hole minimally invasive approach or 2-hole minimally invasive approach vs open approach); thrombosis prophylaxis (warfarin or aspirin vs low-molecular-weight heparin); anesthetic management (general anesthesia or spinal anesthesia vs peripheral nerve blocks); and how surgeons perform transfusions in their patients. Additionally, allogeneic transfusion has been associated with increased infection rates, length of stay, and mortality,3 although these outcomes may relate to other factors.

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