For the first time, The Scarborough Hospital (TSH) has achieved a zero per cent blood transfusion rate for patients having total knee replacements or revisions.
“Achieving this milestone is the result of hard work and dedication by our interprofessional staff and physicians, as well as a concerted effort to work with our patients to truly make them partners in their own care,” said Nurallah Rahim, Interim Vice President for Patient Services at TSH.
TSH is a member of the Ontario Transfusion Coordinators (ONTraC) program, funded by the Ministry of Health and Long-Term Care and administered through St. Michael’s Hospital. ONTraC sets the standard in the province for patient blood management. Blood transfusion rates for patients having total knee replacements and revisions are one of the areas monitored through ONTraC due to the high amount of blood loss that naturally occurs during this surgery.
“Patients who require a blood transfusion during knee replacement or revision surgery can have an increased risk of complications, mortality, and longer hospital stays,” explains Laura McKenzie-Kerr, Patient Blood Management Coordinator at TSH.
“What’s more, these patients usually have less energy following surgery, which impacts when they can begin their physiotherapy and other rehabilitation.”
Since becoming a member of ONTraC in 2003, TSH has instituted a process to ensure patients have an optimal hemoglobin level before surgery – ideally 125 or greater – to help avoid the need for a blood transfusion.
Surgical patients are contacted for a blood test to find out their hemoglobin level at least four to six weeks before their surgery in order to have enough time to optimize their hemoglobin level with iron supplements or infusions.
Laura admits that centralizing all joint surgery at TSH’s General campus in 2015 and having transfusion rates as part of the lab’s scorecard were also strategies that contributed to lowering the transfusion rate.
“In addition, a zero per cent transfusion rate means that the hospital no longer needs to do a ‘group screen’ for knee surgery patients to screen for antibodies and blood type. This is not only a cost savings for our hospital, but also means we’re focused on doing only the blood work our patients need.”
Other areas of focus for TSH as an ONTraC hospital include hip replacement surgery and non-cancerous gynaecological surgeries, such as hysterectomies (removal of the entire uterus) and myomectomies (removal of fibroids from the uterus).
“Although our transfusion rates are low in both of these areas, based on our success with total knee replacements and revisions, we know we can achieve a zero per cent transfusion rate here too!”