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Administrative Section The Value of a Salaried Hospital Recruiter for Blood Donors R. G. CHAPMAN AND A. BLEVINS From the Denver Veterans Administration Hospital and the Rclle Bonfils A.lcrnoria1 Blood Bank, Denver, Colorado The employment of a salaried individual for recruitment of blood donors to replace blood trans- fused to patients at the Denver Veterans Adminis- tration Hospital has resulted in an average in- crease of 1,566 units of blood replaced per year since 1966. The recruitment program is described and results compared to the nearby Colorado Gen- eral Hospital which has the same physician staff and similar sources of patients. The latter hos- pital, without a similar donor recruitment program during this period showed no improvement in amount of voluntary blood replacement. This very successful approach to donor recruitment at the Denver Veterans Hospital has more than offset the cost of the program to the hospital. THE DIFFICULTY in recruiting volunteer blood donors needs no added emphasis. A considerable number of donors are relatives and friends of patients receiving blood, but these provide only partial replacement of the blood used. Their reasons for volun- teering are both altruistic and selfish.2, 5 The latter motivations including both the desire to have blood available in case of need and also the avoidance of cost to the patient for blood not replaced. The elimi- nation of the financial inducement by med- ical insurance payment for blood has seri- ously weakened donor recruitment.4 The Veterans Administration Hospital program in which the patient is not charged for blood received has no financial inducement Received for publication November 8, 1971; ac- cepted March 30, 1972. to donate blood and, at least in Denver, had a very low record of blood replacement (see Figure 1 during the years before 1966). Recognizing this problem in recruitment of voluntary blood donors, the Denver Veterans Administration Hospital in 1965 established a full-time position for the re- cruitment of blood donors to replace blood given to patients. This hospital does not maintain its own blood bank but depends on the Belle Bonfils Memorial Blood Bank of Denver for this function. The dramatic change in rate of voluntary blood replace- ment at this hospital after the recruiter began work in early 1966 is evident in Fig- ure 1. Shown for comparison is the experi- ence at neighboring Colorado General Hos- pital which obtains its blood from the same blood bank. Colorado General Hospital and the Denver Veterans Hospital are similar in size, have the same physicians staffing them, and draw their patients from the same com- munity. The majority of patients at Colo- rado General Hospital are unable to pay full cost of their care, receiving financial assistance from the state of Colorado, Medi- care or Medicaid. It has had no special donor recruitment program like that at the Veterans Hospital, depending instead on physician-family contacts plus the usual, though limited, financial inducement for voluntary blood replacement. Although Transfurion Sept.-Oct. 1972 330 Number 5 Volume 12

The Value of a Salaried Hospital Recruiter for Blood Donors

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Page 1: The Value of a Salaried Hospital Recruiter for Blood Donors

Administrative Section

The Value of a Salaried Hospital Recruiter for Blood Donors

R. G. CHAPMAN A N D A. BLEVINS

From the Denver Veterans Administration Hospital and the Rclle Bonfils A.lcrnoria1 Blood Bank, Denver, Colorado

The employment of a salaried individual for recruitment of blood donors to replace blood trans- fused to patients a t the Denver Veterans Adminis- tration Hospital has resulted in an average in- crease of 1,566 units of blood replaced per year since 1966. The recruitment program is described and results compared to the nearby Colorado Gen- eral Hospital which has the same physician staff and similar sources of patients. The latter hos- pital, without a similar donor recruitment program during this period showed no improvement in amount of voluntary blood replacement. This very successful approach to donor recruitment a t the Denver Veterans Hospital has more than offset the cost of the program to the hospital.

THE DIFFICULTY in recruiting volunteer blood donors needs no added emphasis. A considerable number of donors are relatives and friends of patients receiving blood, but these provide only partial replacement of the blood used. Their reasons for volun- teering are both altruistic and selfish.2, 5

T h e latter motivations including both the desire to have blood available in case of need and also the avoidance of cost to the patient for blood not replaced. The elimi- nation of the financial inducement by med- ical insurance payment for blood has seri- ously weakened donor recruitment.4 The Veterans Administration Hospital program in which the patient is not charged for blood received has no financial inducement

Received for publication November 8, 1971; ac- cepted March 30, 1972.

to donate blood and, at least in Denver, had a very low record of blood replacement (see Figure 1 during the years before 1966).

Recognizing this problem in recruitment of voluntary blood donors, the Denver Veterans Administration Hospital in 1965 established a full-time position for the re- cruitment of blood donors to replace blood given to patients. This hospital does not maintain its own blood bank but depends on the Belle Bonfils Memorial Blood Bank of Denver for this function. T h e dramatic change in rate of voluntary blood replace- ment at this hospital after the recruiter began work in early 1966 is evident in Fig- ure 1. Shown for comparison is the experi- ence at neighboring Colorado General Hos- pital which obtains its blood from the same blood bank. Colorado General Hospital and the Denver Veterans Hospital are similar in size, have the same physicians staffing them, and draw their patients from the same com- munity. The majority of patients at Colo- rado General Hospital are unable to pay full cost of their care, receiving financial assistance from the state of Colorado, Medi- care or Medicaid. I t has had no special donor recruitment program like that at the Veterans Hospital, depending instead on physician-family contacts plus the usual, though limited, financial inducement for voluntary blood replacement. Although

Transfurion Sept.-Oct. 1972

330 Number 5

Volume 12

Page 2: The Value of a Salaried Hospital Recruiter for Blood Donors

Volume 12 Number 5

HOSPITAL RECRUITER EOR BLOOD DONORS 33 1

D a n v a r V e t e r a n s H o s p i t a l

- t r a n s f u r a d

--- r e p l o r a d

r e c r u i t m e n t p r o g r a m b e g u n I

4i 1

I i 0 --..---------d .

1 9 6 0 1 9 6 2 1 9 6 4 1 9 6 6 1 9 6 8 1 9 7 0

C o l o r a d o G a n e r o l H o s p i t a l

1 9 6 0 . 1 9 6 2 1 9 6 4 1 9 6 6 1 9 6 8 1 9 7 0

Y a o r

FIG. 1. Annual amounts of blood transfused and voluntarily replaced.

Colorado General Hospital had a much higher initial rate of voluntary blood re- placement, no increase occurred after 1966 despite a progressive rise in the amount of blood transfused.

The blood donor recruitment position at the Denver Veterans Administration Hos- pital is filled by a GS-5 employee who had previously been a volunteer worker but without experience in blood donor recruit- ment. T h e average rate of donation in- creased by 1,566 units per year after she began work. The hospital receives $12.50 credit for each unit replaced, thus a saving of $19,575 per year accrued to the hospital, more than offsetting the salary and minor overhead expenses of the recruitment pro- gram. The success of this program depends greatly on the person employed. It is very doubtful that simply establishing this posi- tion or adding these duties to an employee already busy with other activities would be nearly so successful. The recruiter must be

well motivated, persistent and enjoy talking with patients and their families. These qualifications are emphasized by the studies of Grace3 and the demonstration by Condie and Maxwell2 that personal contact is much more effective than general appeals through the news media.

The blood donor recruiter at the Denver Veterans Administration Hospital learns within one working day of all transfusions given and she contacts the patients immedi- ately. If the patient is too ill or unable to talk, she speaks to the family instead, pref- erably on the ward when they are in for a visit. In this contact she explains the need for blood and how to replace that given the patients so that others may have blood avail- able when they need it. If the patient is from out of town she gives the name and location of the blood bank nearest his home. If the family is not immediately available for contact, she will look for them later during one of her frequent visits to the

Page 3: The Value of a Salaried Hospital Recruiter for Blood Donors

332 CHAPMAN AND BLEVINS

wards. This seems more effective than leav- ing word with the nurses or clerks to ask the families to stop at her office near the hospital lobby. She keeps careful records of transfusions and replacements. Letters of appreciation are sent to the donors and families for bloocl replaced. 1E replacement is incomplete, telephone calls are made or follow-up letters are sent at one, three, five and eight months after the patient’s hos- pit;ilization. These letters emphasize the need for blood and how this can be donated lor the patient’s credit by family, friends and community organizations. Hospital rec- ords are checked so these letters can mention how many immediate family members there are who might donate, and any donations already received are acknowledged. The first two letters go out over the recruiter’s signature, the last two over the Hospital Director’s. A tactful approach is needed in this procedure ant1 the full sequence of letters is not completed if there is any indi- cation of antagonism. Fortunately this has rarely been a problem. For patients living away from Denver who have been initially contacted in person, the first follow-up letter does not go out until two months have elapsed without blood replacement.

An added benefit of the recruiter’s record keeping is a readily available source of statistical information for the hospital. These records are summarized monthly to show the Transfusion Officer and the Medi- cal Executive Committee the number of transfusions given including single unit transfusions and the use of component therapy as opposed to whole blood.

The success of this effort indicates the value of such a program in hospitals serving patients who have no financial inducement to replace transfused blood. In a Veterans Administration Hospital where unreplaced blood represents a direct charge to the hos- pital budget there is a strong inducement

Transfusion Sept.-Oct. 1972

lor the hospital to establish a salaried re- cruiting position. Where cliarges are ab- sorbed by third-party insurance coverage such as Medicare, the hospital administra- tion has less to gain. Possibly the insurance carriers could be induced to defray the costs of recruitment i n this case. Other recruit- ment procedures are wailable in private- care institutions. Churg et al.1 have de- scribed success with pie-admission bloocl donation in ciibes of elective surgery. The data in their report suggest, however, greater success in decreasing the amount of blood transfused than in increasing the amount donated.

Acknowledgments T h e authors express their appreciation to the

Transfusion Committee of Colorado General Hos- pital for permission to cite transfusion statistics from thcir institution.

The full-time position was instituted by Dr. J. W. Hall, then Chief of Staff of the Denver Veterans Administration Hospital.

References 1. Churg, J.. P. Steinlauf, R. Brill, J. R. Gannon,

A. S. Ellis, H. J. Sobel. and I. Weiss: Pas- saic Valley blood program. A report of six years experience with community approach to blood procurement. Transfusion 11: 102, 1971.

2. Condie, S., and N. Maxwell: Social psychology of blood donors. Transfusion 10: 79, 1970.

3. Grace, H. A.: Blood donor recruitment: a case study in the psychology of communica- tion. J. SOC. Psychol. 46:269, 1957.

4. Green, D. W.: Trends in blood banking. Legal and procurement problems plague blood banking. Hospitals 42: 56, Julie 16, 1<3(iB.

5. London, P., and B. M. Hemphill: T h e motiva- tion of blood donors. Transfusion 5: 559, 1965.

Robert G. Chapman, M.D., Associate Professor of Medicine, University of Colorado Medical Cen- ter, 4200 East Ninth Avenue, Denver, Colorado 80220.

Alice Blevins, Chief, Blood Replacement Unit, Veterans Administration Hospital, 1055 Clermont Street, Denver, Colorado 80220.