Jason Lee, MD
Blood Conservation Program
“Receiving blood is a gift, donated by volunteers who sacrifice their time. It also comes with some inherent risks. That’s why the decision to transfuse should be made judiciously, to conserve the supply and keep patients safe.”
After Dr. Lee finished his pathology training at Stanford University in 2008, he joined The Permanente Medical Group and soon became director of the blood bank at Kaiser Permanente Santa Clara, where he noticed a trend: blood transfusions were on the upswing.
A closer examination revealed that physicians commonly ordered red cell transfusions when patients’ hemoglobin concentration fell below 10 g/dL, even though recent randomized trials had shown that liberal transfusions are not beneficial and observational studies associated transfusion with numerous untoward outcomes. “There were no real guidelines at the time, and most physicians relied on what they’d learned in medical school,” says Dr. Lee. “Because there is always a risk of complication from transfusion, I wanted to see if we could do a better job conserving this precious resource and keeping patients safe.”
So Dr. Lee created a restrictive transfusion guideline, educated clinicians on the evidence supporting a conservative trans-fusion strategy, and helped embed decision-support tools in our electronic medical record system to make it easy for clinicians to do the right thing. Once the KP Santa Clara program was successful, Dr. Lee worked with local and regional partners to help all medical centers revitalize their local blood utilization committees, set up data analysis and review processes, and further promote physician education.
“Within a year and a half of launching the program across the region in 2010, nearly every medical center was reaching its targets in terms of not ordering transfusions unless hemoglobin levels fell below 7, and then reassessing before giving a second unit,” says Diane Craig, MD, assistant physician-in-chief for hospital operations at KP Santa Clara.
Since 2010, blood utilization has decreased 35% across KP Northern California, despite a significant increase in KP members.
“Dr. Lee recognized an opportunity for improvement based on recent research, developed a systematic solution, and helped physicians learn collaboratively to make a difference,” says Stephen Parodi, MD, TPMG associate executive director. “His contribution represents evidence-based medicine at its best.”