Waikato DHB saves millions with new blood service

Waikato District Health Board is saving itself millions of dollars by examining patient's blood before major surgery, boosting levels if they're low.

In a New Zealand first, the DHB has set up the Blood Management Service which sees patient's blood analysed and potentially boosted if needed.

Dr Scott Robinson, the clinical leader for the service, wanted to find a way to make the process nicer for patients and more efficient for the hospital, rather than having to rely on donated blood which costs hospitals millions of dollars.

"No other hospital in New Zealand has it, so we're a first. It's come about as it's recognised that blood is very expensive and it's an increasingly scarce resource."

After its first year of operation, the service has saved the DHB $2.4 million - three times the expected $800,000 target.

"So we're pleased," Robinson said.

The service meant the DHB didn't have to rely so much on donations.

He said that while blood transfusions - which he likened to a liquid transplant - helped save lives in critical situations, they were taxing on the body and subjected the patient to higher risks of infection, surgical complications and possible recurrence of cancer.

To qualify for the new service, the patient meets with their GP before deciding that a major surgery was necessary.

They will then be brought in to have their blood tested. If their levels are low they will be given an iron infusion to boost their red cell count.

"It's recognising that the patient's own blood is the best blood for them and the best place for it is in their blood vessels and so we try and keep it there when they come in for operations.

"So if their blood levels are not high enough - so they're anaemic - that makes them more likely to require a transfusion if they were to bleed during major surgery, so if we were to boost that before they have their surgery, naturally by giving their body the things that it needs to produce more blood then that can prevent them from having a transfusion and essentially that's what it's all about."

They also use a cell saver machine - which sucks up blood that bleeds out of the patient, it then washes and filters it before giving it back to the patient - during the operations.

Robinson said that process alone had saved the DHB about $500,000 worth of blood products and about 1,100 donations.

The blood itself is big business - each red blood cell unit costs about $1 per ml.

The savings have also hit cardiac surgeries by using a special machine, thromboelastograph, that provides patients specific products to help fix bleeding problems.

"It's saved us about $500 per cardiac surgical patient going through, so that's another saving."

Considering the hospital does up to 700 cardiac patients a year - 680 during the first year - it was a boost.

Hamilton woman Jana Rowlands used the service recently and said it changed her life as she discovered she was anaemic prior to surgery.

"I had low iron in my blood and that was why I was feeling so tired which was one of the reasons I went to the doctor because my get up and go got up and went. I was just so tired all of the time and I couldn't figure out why."

A week after her surgery she was beginning to feel better.

"After surgery, everyone was very pleased about how quickly I recovered from the surgery ... if you're healthy going in, it is much easier to recover."

Robinson said if Rowlands had her surgery prior to the service being set up they would have been unlikely to have recognised her anaemia.

The pre-operative work had also seen them pick up a variety of cancers, including blood cancer and bowel cancer, he said.

He now hopes the service can be rolled out to the rest of the country's hospitals.

BLOOD SAVING SERVICE
• Each red blood cell unit costs $1 per ml,
• A whole unit, 300mls, is about $300,
• Platelets $4 per ml,
• 1,100 donations by new service,
• $500 saved for each cardiac surgery patient,
• Overall, Waikato DHB saved itself $2.4million in 12 months - three times the expected $800,000