Hemostasis machine saves $140,000
Hemostasis machine saves $140,000
Machine cuts blood use nearly in half
St. Francis Hospital and Health Centers of Beech Grove, IN, has been able to cut costs and improve customer satisfaction by using two new machines for cardiac patients. Last year, the hospital switched to the Hemostasis Management System (HMS) and saved $140,000 in total blood product usage. Those savings translated into about $50,000 when expenses, including the initial cost of two machines, were factored into the equation, says Joe Doescher, CCP, a cardiac perfusionist at St. Francis. The list price for one HMS machine is $23,000. Trial results aren’t in yet, but a second machine, a Thrombelastograph (TEG), is expected to save $40,000 a year. Its cost, including software, is $17,400.
Initial outcomes with HMS were a 38% reduction in overall blood product utilization, Doescher says. The hospital has used two of the machines for more than a year now, and the most recent results are even better a 45% reduction in overall blood product utilization.
"What this translates into and this is most important is that we improved patient care and reduced costs at the same time," Doescher says. "You’re not subjecting patients to all the possible transfusion diseases and complications," he adds. "Blood products insult the immune system, and by subjecting patients to less blood, we’re lessening that insult."
The machine reduced chest tube drainage by nearly a third, and postsurgery bleeding complications dropped from a pre-HMS 5% to 6% to 1.5% to 2%. One surgeon told Doescher that he thinks the unit has not seen as many patients with transient neurologic deficits since switching to HMS.
How HMS works
The traditional method of examining a cardiac patient’s blood is to measure activated clotting time (ACT) ideally 480 seconds. "But there are a lot of variables affecting ACT once you go on pump or bypass," Doescher says. "Sometimes the ACT will give you a false sense of security. You may think the patient is adequately heparinized when it’s not the case."
The HMS machine tests the patient’s sensitivity to heparin and recommends the dose or concentration of heparin to be administered. The perfusionist puts a cartridge in the machine and reads the data. As the case progresses, different levels of cartridges are inserted, depending on the level of heparin that must be maintained. "All you do is run those cartridges, and the machine tells you exactly where you are in relation to where you should be. It recommends how much if any heparin to give the patient," Doescher says.
When the surgery is completed and the heparin needs to be reversed, the perfusionist traditionally would use the Bull dose response curve to determine how much protamine to give the patient.1 The HMS machine measures the correct amount of protamine necessary to reverse the heparin concentration in the patient. The HMS is manufactured by Medtronic Blood Management, a subsidiary of Medtronic of Parker, CO.
The perfusion staff at St. Francis then needed to improve its method of determining what blood products patients needed. The old method measured prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen level, and platelet count to determine if a patient needed blood products. Then progress was monitored. The TEG, manufactured by Haemoscope of Skokie, IL, analyzes clot formation and produces data that correspond to deficiencies existing in the coagulation factors. For example, one value will correlate to the fresh frozen plasma requirement, another will indicate that cryoprecipitate is needed, and a third might show that platelet function or count is poor.
"By using the TEG, we’re able to move away from doing PTs, APTTs, and fibrinogen levels," Doescher says. "The machine takes away the guesswork about what product the patient really needs."
Doescher recommends that cardiac units obtain full support from cardiac surgeons before switching to the new systems. "Unless you have the surgeons’ support and their willingness to go this route, making the switch won’t work," he says. "I like to think our surgeons are team players and that they’re willing to listen to new ideas and new concepts. I hope they’ll give a new device or procedure a shot as long as it doesn’t harm or endanger patients."
Reference
1. Bull BS, Korpman RA, Huse WM, et al. Heparin therapy during extracorporeal circulation. J Thor Cardio Surg 1975; 69:674-689.
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