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Our Stories

Patient blood management takes patience

Toronto, May 1, 2014

By Geoff Koehler

Anna Nassis monitors one of her patients
One of St. Michael’s two patient blood management co-ordinators, Anna Nassis monitors one of her patients. (Photo by Katie Cooper)

St. Michael’s Hospital doesn't have a provincial patient blood management co-ordinator. It has two.

These two nursing positions have been integral to managing perioperative patients. They’ve also helped to avoid unnecessary blood transfusions, reduce infections and length of stays, and save the health care system millions of dollars.

As an Ontario Nurse Transfusion Co-ordinator – or ONTraC – site, St. Michael’s has been working for more than a decade to reduce the use of transfusions for elective surgeries such as hip and knee replacements and coronary artery bypass grafts. Two years ago, St. Michael’s became a Centre of Excellence for Patient Blood Management.

In 2013, St. Michael’s had the province’s lowest transfusion rate for bypass surgery – a testament to the patient blood management coordinator role and hospital-wide commitment to delivering the right care to patients at the right time.

"Three to five weeks before surgery, we identify the patients who have conditions that might make them more likely to need a transfusion," said Alanna Howell, one of St. Michael’s patient blood management coordinators. “By recognizing high-risk patients before their surgeries, we have time to work with care teams to optimize these patients for surgery.”

Patients with medical conditions such as anemia are most commonly flagged. The coordinators liaise with the patient, family physician, surgeon, anesthetist, hematologist and others to create a care plan before, during and after surgery.

"Blood management takes more time and work," said Anna Nassis, patient blood management coordinator. "It's a lot easier to make a phone call during surgery and say 'Send me a unit of blood' than it is to pre-treat patients for weeks before surgery and to develop a plan for alternatives during and after surgery. But 'it's hard' isn't a reason to shy away from doing something that helps everyone."

The paradox of transfusion is that while it may benefit some patients, it also has the potential to harm.

The percentage of patients with anemia identified by Howell or fellow nurse coordinator, Anna Nassis, varies depending on the type of procedure. Between 40 and 70 per cent of surgical patients require some blood management planning.

ONTraC, which includes 25 Ontario hospitals, is funded by the Ontario Ministry of Health and administered through St. Michael’s. At a cost of $3.2 million, the program saves Ontario $15 million a year in blood products and $47 million in total.

By the numbers

Since St. Michael’s began measuring transfusion rates, there have been incredible reductions for elective surgeries such as hip and knee replacements, and coronary artery bypass grafts.

Comparison of St. Michael’s baseline patient transfusion rate from the first year it was measured against 2012 and 2013.

Procedure Baseline patient transfusion rate per cent (first year)Patient transfusion rate per cent in 2012Patient transfusion rate per cent in 2013
Coronary artery bypass graft 60.9 (2002) 30.0 10.0
Single knee replacement 17.6 (2002) 13.5 1.7
Single hip replacement 22.6 (2007) 17.5 15.1

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

See More of Our Stories in 2014