A number of compounding factors are contributing to a national shortage of blood products, which the American Red Cross (ARC) is now calling a “blood crisis.”
The surge of U.S. Omicron COVID-19 cases and hospitalizations, inclement winter weather and ongoing labor issues are driving a decline in donor turnout and canceling blood drives across the country ─ with supply falling to its lowest levels in more than a decade.
Early in the pandemic, hospitals largely had access to ample blood products while treating COVID-19 patients ─ but an April 2020 Premier/Bloodbuy survey of regional blood centers noted that supply needed to increase as much as 50 percent to prepare for the resumption of elective procedures that spring.
Instead, the U.S. has seen a 10 percent decline in the number of people donating blood since the pandemic’s onset and a 34 percent decline in new donors last year. Outside of a pure supply issue, the nationwide staffing crisis has also impacted blood supply with respect to collections and deliveries.
As a result, this more limited supply is rationing blood distributions to many U.S. hospitals with some holding only a day’s worth of inventory. This can be a particular problem in rural areas of the country, where hospitals have fewer options for local blood banks, with some facilities located hours away.
What Can Be Done
First, hospitals and blood centers will need to coordinate to ensure adequate response to increased blood needs.
- Promote the need for blood donation and coordination on blood drives: Hospitals and blood centers will need to coordinate on blood drives and related timing so that blood centers can appropriately publicize the need for donations, communicate effectively with donors and schedule appointments. Many hospitals are also partnering with other organizations within their communities to get the message out about the vital need for blood donations.
- Conserve inventory on hand: Hospitals and blood centers should partner on the inventory levels hospitals keep on their shelves. Given these unprecedented circumstances, it may be unsustainable for hospitals to carry more than three days’ inventory, as that could place a strain on availability and short another hospital in the region.
- Update stakeholders on changes in clinical guidance: Blood centers will look to hospitals to share information about any alterations in transfusion guidelines, so blood centers are aware of any potential changes to utilization patterns going forward.
- Investigate a secondary blood supplier. Premier’s affiliate Bloodbuy is ideal for sourcing products not available locally and works alongside a hospital’s primary supplier. Bloodbuy's rapidly growing user base of over 80 leading health systems consists of hospitals and integrated delivery networks (IDNs) of all sizes ─ from large academic medical centers to community-based providers in rural areas.
The continued strain on the nation’s blood supply is also encouraging hospitals and health systems to take a critical look at their transfusion and blood management practices. While no two patient blood management programs are alike, they often include education aimed at guiding providers toward optimal decision-making, clinical decision support tools, benchmarking data and evidence-based guidelines to improve utilization practices. Components of a contemporary blood management program include:
- Commitment, leadership, and governance. An organizational commitment to the blood management process and an expert-driven leadership team that can review evidence-based practice guidelines, governance and tracking process for transfusion of blood and blood products.
- Program oversight. A transfusion committee or a transfusion-focused subcommittee of an existing Pharmacy, Nutrition and Therapeutics or Quality committee is essential for oversight of blood utilization.
- Development, review, and implementation of evidence-based transfusion guidelines. These guidelines need not be developed from scratch as many professional societies and organizations have already reviewed and vetted the literature ─ and put forth population and blood component-specific recommendations for transfusion. Examples include restrictive transfusion threshold guidelines based upon cutoff hemoglobin levels and single-unit transfusion policies for red blood cell transfusion.
- Adherence monitoring and outlier management. Once evidence-based guidelines are agreed to and in place, a rigorous process of monitoring and outlier management is essential as a “feedback loop” for appropriate blood and blood component utilization. Often, a service line or disease-based performance improvement initiative is required to truly identify and eliminate unwarranted variation from clinical guidelines.
- Data, Data, Data. Use of data is crucial to assess and inventory current practices in blood utilization, as well as transfusion rates for certain procedures. By leveraging data, providers can monitor the number of transfusions that fall outside evidence-based guidelines and physician compliance. Using the PINC AI™ Healthcare Database, for instance, providers can easily capture and track patient information and get actionable data, aggregating all MS-DRGs to evaluate transfusion use or number of units of blood ordered. The snapshot provides a simple, easy way to trend monthly or annually to examine excessive use of blood.
- Information technology enablement. Many of the transfusion clinical guidelines can be supported by existing technology. Blood utilization guidelines can be built into the organization’s Computerized Physician Order Entry (CPOE) modules and supported by evidence-based Clinical Decision Support Systems (CDSS). Using PINC AI™ technology and data, providers have a compass, helping them improve blood use variation and measure progress against benchmarks. Whether looking at blood utilization overall or pinpointing specific procedures that account for significant blood use, providers can drive real change across services lines and apply evidence-based practices around effective blood use.
Premier remains steadfast in our commitment and partnership with members to improve access to blood and blood products and help mitigate disruptions.
- We’re continuously working with Bloodbuy and other suppliers to assess blood and blood product inventory and leverage technologies to facilitate the efficient distribution of lifesaving blood products to providers across the nation.
- Regardless of facility profile and underlying patient population, hospitals benefit from access to Bloodbuy’s digital supplier network comprised of over 30 industry-leading, independent blood centers. Many regions are serviced by one major blood supplier, which results in little to no competition and the limited sharing of real-time (or even recent) market information relating to per unit cost and availability for identical blood products. Bloodbuy’s technology enables hospitals and health systems to optimize their blood product procurement by accessing a broader market so a hospital doesn’t have to just buy from local or regional blood suppliers ─ but can go beyond to diversify suppliers – mitigating risk for shortage. All blood centers within the Bloodbuy network are FDA-licensed to supply blood products in all 50 U.S. states and the Caribbean, CLIA certified, and AABB accredited.
- Premier’s consulting team is supporting members in evaluating and optimizing their blood utilization programs. Our team consists of blood bank, laboratory and clinical subject matter experts that can assist with all components of a blood management program to support appropriate utilization.
- PINC AI’s Crisis Forecasting and Planning Tool enables providers to predict surge, prioritize supply and adjust therapies for COVID-19 patients. This tool could predict a hospital's COVID-19 census based on cases at the county level, model supply levels based on estimated case volume and typical surge demand and show inventory availability by supplier. Throughout the pandemic, this has allowed providers to anticipate their needs for products and therapeutics necessary for treating patients.
- Premier also advocates for added health equity and expanding the eligibility criteria for blood donors, including LGTBQ+ donors previously deferred as well as individuals who may not meet height and weight requirements and can donate amounts less than a full liter. Officials should also consider regulatory waivers and flexibilities that would allow hospitals to collect and process blood more efficiently and expeditiously.
While disruptions are prevalent, Premier continues to share vital information and best practices – and pursue crucial strategies to help our members, and our nation, get the vital supplies needed to care for patients.
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