Blood Utilization Strategy (BUS)

In 2005, the MOH-LTC approved the implementation of a blood utilization strategy in Ontario with the objective of optimizing the use of blood and blood products in hospitals in the province and consequently achieving efficiencies and improved patient safety related to transfusions. Because of the significant cost of transfusion and transfusion-associated adverse events, cost savings realized by blood management programs can amount to millions of dollars annually.

Ontario is taking a strategic approach to its blood utilization strategy by working in collaboration with hospitals and CBS to implement improvements in blood and blood product utilization. Three regional networks have been created as the mechanism for engaging hospitals and CBS. CBS, hospitals and the MOH-LTC have a shared responsibility to ensure the safe and appropriate use of blood and blood products. The focus of the MOH-LTC strategy is on promoting optimal management within hospital transfusion services.
The strategy is composed of interrelated and complementary components including:
 

• Establishing a provincial blood coordinating office
• Hiring more Transfusion Coordinators within the Ontario Transfusion Coordinators (ONTraC) program
• Continuing quality management initiatives developed in the Quality Essentials For Safe Transfusion (QUEST) programs in Hamilton and Ottawa hospitals
• Expanding Physician, Nurse and Public Education Initiatives like the Bloody Easy Handbook and e-Learning educational tools
• Tracking blood utilization, infectious diseases and noninfectious adverse events. This includes Ontario�s participation in the Transfusion-Transmitted Injuries Surveillance System (TTISS) and the development and implementation of a hospital-based tracking system for blood and blood products
• Developing new strategies for blood utilization management enhancing patient safety

Strategic blood management encompasses the evaluation of current product utilization patterns to identify opportunities to reduce wastage, address variations in transfusion practice, and implement blood management programs to optimize use. In addition to its financial benefits, strategic blood management will improve clinical outcomes and decrease risk exposure.

As a first step, monitoring and benchmarking of blood utilization patterns is being undertaken to identify potential areas for improvement. Options for improved management are designed and targeted and results evaluated. Elements of a blood management program can range from simply raising awareness to the implementation of blood conservation techniques, transfusion alternatives or gate keeping mechanisms to control use.

Initial provincial priorities have been identified and include red cell, platelet and IVIG utilization. Other priority opportunities will be identified through the evaluation of existing utilization patterns in the province. Utilization information will be reviewed with regional partners and individual or collaborative programs introduced to improve use (e.g. product redistribution, dissemination of best practices, peer support, promotion of evidence-based transfusion guidelines).

By promoting appropriate use of blood and blood products, the Blood Utilization Strategy will;

• Help patients avoid the risks associated with blood (e.g., infectious diseases, bacterial infections, adverse events) by avoiding or receiving alternatives to blood transfusion, if possible;
• Support better and more appropriate use of hospitals - the average length of stay and work required by hospital staff is less for patients who avoid or receive alternatives to blood transfusion than for those who receive blood transfusions;
• Identify cost efficiencies in the system - blood and blood products are expensive; for example, one unit of red blood cells costs between $400 and $500 and a commonly prescribed course of Intravenous Immunoglobulin (a fractionated product referred to as IVIg) costs $10,000.
• Complement strategies to reduce wait times -additional procedures being performed in the province to support Ontario's commitment to reduce wait times will create increased demand for blood and fractionated products; 
• Enhance patient safety by helping to reduce the possibility of blood shortages to ensure that blood is available when people need it.

The Blood Utilization Strategy represents a comprehensive and integrated approach to addressing the safety and sustainability of blood and blood products in Ontario.