News

Finding Alternatives to Blood Transfusions a Growing Trend at Ontario Hospitals

Efforts translate into increased safety, quicker recovery times, and better quality of life for patients, as well as millions of dollars in annual savings for province

Newmarket, Ontario – May 2, 2008 - Marianne de Bretan-Berg donates blood four times a year. As a nurse, she understands the importance of ensuring that an adequate supply of blood is available for patients in need.

As Coordinator of the Perioperative Blood Conservation Program at Southlake Regional Health Centre in Newmarket, however, she also recognizes that blood is a precious resource, for which there is a higher demand than there are donors, and that transfusions come with a low but definite level of risk – such as fever, infection, allergic reaction and illness – so should be administered with informed consent and only when this is the most appropriate treatment.

That’s why de Bretan-Berg and her colleagues at Southlake Regional Health Centre have taken significant steps to reduce the frequency and volume of blood transfusions in the hospital – particularly for surgeries that may be associated with considerable loss of blood, such as cardiac bypass, knee joint replacement and prostate operations. In the last year alone, Southlake has decreased its use of blood transfusions in pre-scheduled cardiac bypass surgeries by almost 15 per cent. For total knee joint replacement, the frequency of transfusions has dropped by half, and currently, less than five per cent of prostate surgery patients receive blood transfusions – down from almost 21 per cent two years ago.

These efforts are part of Southlake’s innovative Perioperative Blood Conservation Program – an initiative of the Ontario Nurse Transfusion Coordinators (ONTraC), launched by the Ontario Ministry of Health and Long-Term Care in 2002, which has resulted in improved patient safety. The ONTraC program was introduced following the release of the Krever Commission report in 1997, which examined how thousands of Canadians contracted HIV/AIDS and hepatitis C from blood products. The program’s goal is to develop blood conservation methods, reduce transfusions and promote appropriate use of blood products throughout the Ontario hospital system.

As part of the program, de Bretan-Berg was hired as a full-time coordinator to meet with patients up to six weeks before their surgeries whenever possible – to test their hemoglobin (red blood cell) levels and explore potential alternatives to blood transfusions.  If a patient’s hemoglobin is low (a condition called anemia), de Bretan-Berg investigates the cause and develops a plan to raise it before surgery, working closely with surgeons, anesthesiologists, perfusionists, nurses,  pharmacists, lab technicians and hospital support staff as necessary. The plan may include having the patient follow a diet high in iron-rich foods and protein, or take iron supplements or other medications, such as injections of an erythropoiesis-stimulating agent which helps increase red blood cell production.

“Through our efforts, patients are feeling better, healthier and more energetic, and have a faster recovery and overall better quality of life,” said de Bretan-Berg, who will be travelling to the U.S. in September to present her hospital’s experiences and outcomes at an international conference on blood management.  “We also teach patients about healthy lifestyle choices to boost their blood levels after surgery so that they are able to recover more quickly from surgery.”

The ONTraC program has been implemented in 25 hospitals across the province, and ONTraC nurses province-wide collaborate closely as part of their work. According to Dr. John Freedman, ONTraC Program Director, estimates are that the program saved the province about $13 million in 2006-2007 alone, through reduced expenses for blood products, lab work, nurses needed to hang blood by the bedside, and shortened length of hospital stays. “This is an extremely successful program that benefits hospitals, the Ministry of Health, and most especially, patients,” Dr. Freedman said.

“We’re delighted with Southlake’s participation and preliminary data indicates that Southlake has been highly successful with the program,” he said. “Overall, we have achieved a 30 per cent average reduction in transfusions across the province in targeted surgical procedures, and we’re grateful to the Ministry of Health and Long-Term Care for supporting this project.”

For Alliston resident Michael Tighe, who underwent cardiac bypass and valve surgery at Southlake last month, the Blood Conservation Program made a significant difference in the length and quality of his recovery. Being anemic prior to coming to hospital, Tighe might have otherwise been a candidate for a transfusion, particularly given that this type of surgery is generally associated with a high blood loss. Through the program, though, de Bretan-Berg was able to increase his blood count sufficiently so that he didn’t require any blood during or after the surgery.

“We’re not saying that patients shouldn’t be given blood,” de Bretan-Berg emphasized. “Rather, we’re saying ‘give blood appropriately, and if there’s something we can do to avoid blood transfusion, let’s do it.’”

For more information about the Perioperative Blood Conservation Program, please visit www.ontracprogram.com

Back to NEWS page