October 21, 2016 — Blog Post
Empowering Physicians to Make Better Decisions about Blood Products
At Emmi, our job is to take complex medical information and communicate it to patients is a clear, actionable way. We know that time with your healthcare team is limited, so we use technology to make sure your interactions with them are as productive and as collaborative as possible. That’s the power of clarity: getting you the information you need so you can take action.
I spoke with two doctors who are successfully harnessing that power for physicians. Their goal: lower the amount of blood products physicians use to reduce unnecessary blood transfusions. And they’re doing it by gathering the latest literature as well as feedback from physicians and turning it into concise education and clear criteria for giving a transfusion.
Dr. Judy S. Lyzak, VP of Medical Affairs for Alverno Clinical Laboratories in Hammond Indiana, says the challenge stems from a historical lack of training on transfusion medicine. “Back when I was educated, it wasn’t a real focus in medical education,” she says. “And this paradigm existed that you could not hurt a patient with blood products. If they need one unit of red blood cells, they need two. In the past several years, we’ve learned that’s absolutely not the case.”
But keeping up on the evolving literature is not an easy task. “I don’t fault the doctors, there’s just so much they have to keep up on. We try to distill it down for them.”
Dr. Robert C. Stump, Medical Director of Blood Products at Franciscan St. Francis Health in Indianapolis, IN, agrees. When it comes to changing physician prescribing habits on giving blood, “what’s helped a lot is education,” he says. “But if you don’t enforce it, what’s the point? So we also changed the order set and that helped dramatically.”
To guide physicians on the best prescribing habits, Dr. Lyzak and Dr. Stump developed a program at Franciscan Health hospitals based on restrictive criteria for using blood products. They also created robust order sets in the EMR that every physician must go use. This allows them to audit the use of blood products and follow up with physicians who are not prescribing according to the criteria to provide more guidance. And the results have been a significant reduction in unnecessary blood transfusions.
“We don’t expect them to be right 100 percent time but we do expect them to think,” says Dr. Lyzak.
Now that the order sets have been successful, the next step in their mission is changing the way physicians and patients alike think about anemia. Treating the condition before surgery may make blood transfusions unnecessary. “Anemia is not normal,” says Dr. Lyzak. “It’s not physiologic. It’s pathologic.” Dr. Stump says the concept of the “surgical home” is key to an early diagnosis of anemia. “The whole concept of the surgical home is to bring all specialists under one roof and get patient as good as possible for surgery.”
And both physicians agree that patients can play a role in reducing unnecessary transfusions as well. “I’ve had quite a few discussions about blood products, almost always initiated by patients,” says Dr. Stump. But they are usually overly concerned with the rarest complications like HIV transmission, he says, instead of the more likely complications like transfusion-related acute lung injury (TRALI) or transfusion associated circulatory overload (TACO). This is where improved health literacy comes in. Dr. Lyzak says adjusting the informed consent process to focus on these more likely complications rather than the “lightning strikes” is important.
Overall, though, Dr. Lyzak and Dr. Stump agree that clarity is just as important for patients as it is for physicians. Says Dr. Lyzak, ”We have clarity that there is a definite risk/benefit profile. And we need to be clear with patients what the risks are, what the benefits could be, and what the alternatives are.”
To read more about blood transfusions and health literacy, also check out Blood: The Gift You May Not Need by Paul Barr: @BarrPaulJ
Dr. Lyzak is board-certified in Anatomic and Clinical Pathology, trained at the University of Health Sciences Center in Houston, Texas, and the University of Chicago Hospitals, and obtained her MBA at the University of Massachusetts in Amherst.
Dr. Stump has been the Medical Director of Blood Conservation at Franciscan Health, Indianapolis, Mooresville and Carmel, IN since 2011. He has been a member of the Franciscan Health Department of Anesthesia since 1981. He received his medical degree from Indiana Unviersity School of Medicine and his Bachelor degree from Purdue University.