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Special Communication
Less Is More
January 2018

Promoting High-Value Practice by Reducing Unnecessary Transfusions With a Patient Blood Management Program

Author Affiliations
  • 1Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
  • 2Department of Internal Medicine, NYU Langone Health, New York, New York
  • 3Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
  • 4Johns Hopkins Health System Blood Management Program, Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland
JAMA Intern Med. 2018;178(1):116-122. doi:10.1001/jamainternmed.2017.6369
Abstract

Although blood transfusion is a lifesaving therapy for some patients, transfusion has been named 1 of the top 5 overused procedures in US hospitals. As unnecessary transfusions only increase risk and cost without providing benefit, improving transfusion practice is an effective way of promoting high-value care. Most high-quality clinical trials supporting a restrictive transfusion strategy have been published in the past 5 to 10 years, so the value of a successful patient blood management program has only recently been recognized. We review the most recent transfusion practice guidelines and the evidence supporting these guidelines. We also discuss several medical societies’ Choosing Wisely campaigns to reduce or eliminate overuse of transfusions. A blueprint is presented for developing a patient blood management program, which includes discussion of specific methods for optimizing transfusion practice.

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