Evidence-based medicine: Save blood, save lives

Emily Anthes in Nature:

Blood1In 2009, a major California hospital was looking for ways to cut costs. Stanford Hospital and Clinics was on track that year to purchase nearly US$6.8 million worth of blood for transfusions. But a growing body of evidence was suggesting that physicians could often forego the procedure. So, beginning in July 2010, whenever a clinician used the hospital's computerized ordering system to request blood, it would call up the patient's most recent lab results. If the numbers indicated that she or he should be healthy enough to get by without a transfusion, an alert would pop onto the screen gently reminding the doctor of the guidelines and requesting further justification for the order.

The results, detailed in two papers published in the past 18 months1, 2, were dramatic. The number of red-blood-cell transfusions dropped by 24% between 2009 and 2013, representing an annual savings of $1.6 million in purchasing costs alone. And as transfusion rates fell, so did mortality, average length of stay and the number patients who needed to be readmitted within 30 days of a transfusion. By simply asking doctors to think twice about transfusions, the hospital had not only reduced costs, but also improved patient outcomes. Transfusions are common procedures, at least in developed nations. In 2011, US doctors transfused 21 million units of blood and blood products; in the United Kingdom, the number was nearly 3 million. But although transfusions can be lifesaving, they are often unnecessary and are sometimes even harmful. “I think we were kind of brainwashed into thinking that blood saves lives, and the more you give the better,” says Steven Frank, an anaesthesiologist and director of the blood-management programme at the Johns Hopkins Health System in Baltimore, Maryland. “We've gone 180 degrees, and now we think that less is more.”

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