Del Cielo Home Health & Hospice Corpus Christi, Texas, United States
Background/Case Studies: In 2019, a total of 10.85M blood transfusions occurred primarily in hospitals, with 1.5 million occurring in outpatient settings. While there are compelling reasons for this, there is a case to be made that progress in IV therapy and dialysis at home paved the way for widening the scope of what free-standing agencies can do for medically stable, chronic condition patients. A retrospective study over 1790 episodes demonstrated the low adverse risk home transfusion presents when managed well. Referral sources from the South Texas area expressed interest with a goal of reducing costs associated with transfusions performed in hospitals.
Study
Design/Methods: The AABB’s home transfusion handbook was instrumental in the implementation of this program in accordance with the Regulations for Home Healthcare and Hospices in Texas. A multi-disciplinary team, headed by a hematologist, was created to coordinate home transfusions under substantiated orders of a credentialed MD. The type of transfusion selected was pRBCs transfused with pump assistance. New forms were created to detail nursing visits and consent procedures. Guidelines were devised for physicians to make informed referrals. A home visit is organized a day before the transfusion to engage the patient and family, sign consents, collect blood samples, and select a suitable area for the transfusion. Post-procedure interviews with patient, family and staff were conducted for patient satisfaction and continuing development of the program.
Results/Findings: Four individuals enrolled. A total of 15 units of pRBCs were transfused over eight episodes. These individuals were referred by their Primary Care Physicians using the agency’s requested standards to reduce the risk of reactions. Of the eight transfusions, one minor incident occurred when the port was pulled out and one unit of blood was lost. Four of the transfusions occurred within city limits, where the hospital was five minutes via ambulance. The other four were in a rural community, about an hour away from the hospital. Post-procedure interviews all stated that this saved their loved one’s time and energy by avoiding a trip to the hospital where they would wait much longer for the service. Post-procedure lab work showed that prior deficiencies had normalized because of the transfusion. Conclusions: With careful planning of new policy and procedures related to referral filtering, coordination of services, and management of a multidisciplinary team, it has been demonstrated that a free-standing home health and hospice agency can manage this complex service in a timely manner to meet patient needs. The primary barriers in place for other agencies looking to adopt a similar approach are all related to the novelty of the program. There are currently no payor sources or proper market delineation of services to reduce risk factors for these patient diagnosis groupings.
Importance of research: This research signals a vital shift in transfusion care, moving from traditional hospital settings to patients' homes. This reflects the shift in expectations many patients had after COVID affected the world. For transfusion-dependent patients, home-based care could mean fewer hospital visits and more comfort. It opens new avenues for home healthcare providers, emphasizing their potential role in offering complex services, while also highlighting challenges such as funding and risk management.
