and Surgery Program
By Emily Turk
MedStar Georgetown University Hospital’s recently developed Bloodless Medicine and Surgery Program is meeting a previously unmet critical—and growing— need for thousands of area residents. The program, a first-of-its-kind in the Washington, DC, region, is offering the area’s more than 40,000-strong Jehovah’s Witness community a medical option close to home—and serving the increasing number of patients requesting bloodless procedures because of concerns about blood borne diseases, as well.
“The development of the Georgetown program also reflects a shift in medicine away from dependence on blood transfusion toward more creative strategies of blood conservation, which is good for patients and good for medicine,” says Mark Zawadsky, MD, the program’s medical director and orthopedic surgeon at MGUH.
In hospitals with well-established programs, length of stay decreases, readmissions fall and blood utilization can be reduced by between 30 and 70 percent. With the cost of banked blood on the rise, medical centers like Georgetown are taking a proactive approach to finding medically appropriate and safe alternatives to blood transfusion. In fact, there are nearly 200 bloodless medicine programs nationwide with more underdevelopment.
Georgetown’s program is comprehensive, offering area physicians and their patients care management that begins in pre-admission and continues through hospitalization to discharge. A steering committee representing various Hospital departments has been developed and a group of “preferred providers” has been identified—Georgetown surgeons and sub-specialists with a special interest and experience in bloodless techniques.
The program office is staffed by coordinator Michael Hoffman, who has strong ties to the Jehovah Witness community, and nurse coordinator Richard Verstraete, RN, who helped develop a similar program for cardiac surgery in another area medical center. “The team is on-call for area physicians 24-7,” says Dr. Zawadsky.
A number of safety procedures have been put into place to identify patients, everything from “no blood” arm bands to flagging the patients in the hospital’s database and on documentation charts. Hospital-wide education programs have targeted physicians, nurses and ancillary staff. Patient education materials have been created and a program Web site launched to help patients and physicians better understand bloodless medicine techniques. “We have also established a close relationship with the region’s Jehovah Witness Hospital Liaison Committee, which is comprised of volunteers who help members navigate the healthcare system,” adds Dr. Zawadsky.
The program has a broader goal, too. We hope to create an environment within the Hospital in which there is less reliance on blood transfusion and where blood conservation is the norm,” says Dr. Zawadsky. “Every new resident will be trained in techniques to conserve blood. Of course, there will always be critical situations in which allogeneic blood transfusion is the only way to save a patient’s life. But there are often times when we should ask ourselves a simple question: ‘how can I manage this problem without transfusion?’ The result can be a more innovative approach to medical management that will produce good outcomes for patients. It means approaching care with more active decision making and challenging ourselves.”
“It’s a shift in conventional medical culture that has relied heavily upon transfusion with the ‘10/30’ rule as the trigger. More research evidence exists that a more conservative transfusion trigger is best practice,” says Verstraete.
The “less is better” perspective has resulted in a plethora of techniques used to boost a patient’s blood production prior to surgery, and to limit blood loss during and after surgery. Preoperative administration of the synthetic hormone erythropoietin can stimulate bone marrow to produce red blood cells.
The Cell Saver machine recovers shed blood during surgery, concentrates the red blood cells and washes them before they are re-infused into patients. It is becoming an increasingly common intraoperative strategy. And many procedures that were previously considered unlikely candidates for minimally invasive techniques are now performed laparoscopically.
Post-operative techniques can also be administered to reduce blood loss. Simple strategies, such as minimizing phlebotomy following surgery, administering erythropoietin and iron supplementation and reducing oxygen consumption for critically ill patients, can help reduce blood loss. Cell saver tools can also be utilized post-operatively. “I’m using a technique to re-infuse a patient’s own blood that is lost following knee replacement,” explains Dr. Zawadsky. “Blood slowly draining into the knee for a short time after surgery is normal in this procedure. Now instead of trying to determine when a patient may require a transfusion, the draining blood is collected into a closed loop device with a filter, and infused into the patient.”
All of these techniques, and more, are being practiced more routinely today,” notes Dr. Zawadsky. “The new Georgetown Bloodless Medicine and Surgery Program provides the framework we needed to serve greater numbers of patients?and to provide area physicians with a resource for referral and education. We also hope to become a kind of incubator for new ideas in bloodless medicine?the possibilities for improved patient care are really unlimited if we open our minds to the challenge.”
To refer a patient to MedStar Georgetown’s Bloodless Medicine and Surgery Program, please call 202-444-1797 or 202-444-0543; or page program coordinator Michael Hoffman at 202-405-0307; or nursing coordinator Richard Verstraete at 202-405-0353. Visit the program Web site at www.GeorgetownUniversityHospital.org/Bloodless.