EVERETT — Nearly 8,000 miles from home and after stops in New Jersey and Los Angeles, two Australian health care workers arrived in Everett last week, the final stop on their 12-day trip to the United States.
Dr. Amanda Thomson and Annie Woodhouse sat in a second-floor employee lounge at Providence Everett Medical Center. The room was filled with people dressed in green surgical scrubs, waiting to be paged to help out in one of the nine nearby operating rooms.
The two Australians came to Everett to learn more about the hospital’s blood conservation program.
It is one of an estimated 200 hospitals in the United States trying to reduce the number of blood transfusions given to patients.
The growing worldwide movement seeks to cut down on unnecessary transfusions, both to improve the health of patients and to conserve a limited and, at about $850 a pint, costly resource.
Steps to help reduce the need for transfusions include careful surgical procedures, saving, cleansing and recycling patients’ blood during operations, and helping build up patients’ red blood cells and iron levels before and after surgery.
The two Australian health care workers were able to see some of these blood-saving techniques first-hand during a heart valve replacement surgery by Dr. James Brevig, an Everett cardiovascular surgeon.
“The philosophy makes sense to me,” said Thomson, a blood specialist, or hematologist, at the 500-bed Royal North Shore Hospital in Sydney.
“Blood transfusion is a transplant,” she said. “Our bodies are innately primed to react to against anything foreign.
“If you can avoid that, why not?”
It sounds like a straightforward philosophy, but it’s a movement that’s been 25 years in the making. And both the Australians and their Everett hospital counterparts agreed that it is sometimes still controversial.
Brevig said he understands why. It seems illogical for a health care professional to push to reduce blood transfusions. There’s a suspicion that by withholding a treatment for patients long known as a life-saving procedure, “we’re somehow injuring them.”
But Brevig has developed a point-by-point rebuttal, complete with colorful PowerPoint slides and graphs, which he showed to Woodhouse and Thomson.
The Everett hospital kicked off its blood conservation program in the fourth quarter of 2004. Since then, the number of blood transfusions for heart surgery patients has steadily declined, he said.
During the first six months of this year, only 11 percent of coronary bypass patients needed a transfusion, down from 38.4 percent of these patients in 2003.
Meanwhile, the length of their hospital stays has been shortened, Brevig said. The time they spend on ventilators has decreased. And post-surgery complications for those who don’t get transfusions “are less than those who do.”
“The overall trend is patients are doing better, not worse,” he said.
The question then became: “If we can get a patient through heart surgery without using blood, why can’t they do it with a hip replacement?” Brevig said.
In fact, two Everett orthopedic surgeons, Dr. Ralph Haller and Dr.Clay Wertheimer, began testing blood conservation techniques last year.
Patients were told that they wouldn’t get a transfusion “unless they really, really have to,” Haller told Thomson and Woodhouse. “I didn’t feel like I was going out on a limb,” he said. “Most patients were very happy not to have someone else’s blood.”
For patients undergoing knee joint replacement operations, the change has been dramatic. Typically, 15 percent to 20 percent of the two surgeons’ patients had been given transfusions. That number dropped to zero for the 12 months ending in June, said Trudi Gallagher, a blood conservation coordinator at Providence Everett Medical Center.
Other physicians have taken note, Gallagher said, and also are adopting some of the techniques.
Her next goal is to expand the program to patients undergoing blood vessel surgery, procedures that put patients at high risk for blood loss.
In Australia, blood conservation has yet to become widespread, although Western Australia is moving to a statewide blood management program.
“I’ve been impressed by the enthusiasm of the people in the program,” said Woodhouse, executive officer of the National Blood Authority in Canberra. “What we take back is that it needs to be built from the ground up.”
The trip to Everett, seeing a similar blood conservation program at a New Jersey hospital and attending an international blood management conference in Los Angeles introduced them to a network of people that can help as programs are adopted in Australia, she said.
“It’s very clear that the visit is just the beginning of the relationships,” Woodhouse said.
“We feel like we’re standing at the beginning of something important.”
Reporter Sharon Salyer 425-339-3486 or salyer@heraldnet.com.
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