[D]octors in the region say they’ve figured out how to give hospital patients fewer blood tests, reducing how many times patients get stuck with a needle and lowering the chance they will develop anemia.
The doctors came from eight Vermont hospitals plus Dartmouth-Hitchcock Medical Center in New Hampshire. Working with a roughly $500,000 federal grant awarded in 2014, they say that, through early 2016, they’ve reduced some of the most common blood tests by about 10 to 20 percent.
A data analysis by consultants at Policy Integrity estimate the doctors avoided 1,503 tests for anemia, 1,302 tests for kidney function, 1,175 tests for electrolytes and 207 tests for liver damage. The consultants think that saved up to 37,452 patients from losing about 105 liters of blood.
Blood testing causes anemia in about three-quarters of patients who stay overnight in the hospital, according to the study group.
“I’m hoping that we’re going to reduce the percentage of patients who become anemic because we’re drawing too much blood in the hospital, and I hope as well that people will require fewer transfusions,” said Dr. Allen Repp, a hospitalist at UVM Medical Center who co-led the project.
Repp said all nine hospitals wanted to improve care. Each one assembled a team of at least two people who examined how staff at the hospitals ordered lab tests for patients, drew blood and processed the results.
At UVM Medical Center, Repp said, doctors typically asked for certain blood tests on a daily basis. Staff went around early in the morning — sometimes at 6 a.m. — and often woke up patients to collect blood from those who stayed the night.
Repp said his team, which he led, focused on changing the habit of asking for blood samples daily and, instead, assessing the individual patient’s needs and ordering blood work accordingly. He said the team found that, in some cases, a patient needed to have blood checked only once upon arriving.
At Central Vermont Medical Center in Berlin, Repp said, phlebotomists used to take an extra vial of blood each time they were told to take a sample. The idea was to save the patient from being stuck with a needle again, he said, but the hospital found out that only about 1 percent of those extra vials were used.
“There were a couple of studies that were published (in the field) that were very similar to this project,” Repp said. “I think what’s really quite unique about what we’ve done is we’ve done this majorly across hospitals that aren’t affiliated.”
Dr. Cy Jordan, who manages grant projects with the Vermont Medical Society and co-led the project with Repp, said the doctors felt compelled to reduce unnecessary blood tests for ethical reasons that a nonprofit organization, the Society of Hospital Medicine, raised back in 2013.
“It used to be that (doctors) had this professional, ethical obligation to the individual,” Jordan said. Now that the country is working with limited financial resources to pay for health care, he said, doctors have a professional and ethical obligation to reduce waste.
The group estimates that about $5 billion a year could be saved across the country from eliminating unnecessary blood tests. That’s a fraction of a percent of the country’s $3 trillion in annual health care expenditures.
The Vermont hospitals involved in the effort were Brattleboro Memorial, Central Vermont Medical Center, Northeastern Vermont Regional Hospital, Porter Medical Center (which eventually dropped out), Rutland Regional Medical Center, Southwestern Vermont Medical Center and UVM Medical Center.
