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Effect of hospital culture on blood transfusion in cardiac procedures
Ruyun Jin1, Edy S Zelinka, Julie McDonald
1Medical Data Research Center, Providence Health & Services, Portland, Oregon 97225, USA. ruyun.jin@providence.org
Insights
Hospital setting significantly influences blood transfusion practices in cardiac surgery, more than individual surgeon preferences. This highlights systemic factors in optimizing blood product use.
Area of Science:
- Cardiac Surgery
- Transfusion Medicine
- Health Services Research
Background:
- Variations in blood product transfusion practices were observed across facilities within a healthcare system during cardiac operations.
- Surgeons at the same hospital exhibited similar transfusion rates, suggesting an institutional influence.
- The study aimed to quantify the impact of hospital environment on individual surgeons' transfusion behaviors.
Purpose of the Study:
- To determine the relative contributions of hospital and individual surgeon factors to variations in blood transfusion practices.
- To analyze transfusion data for coronary artery bypass graft (CABG) operations across multiple healthcare facilities.
Main Methods:
- Retrospective review of blood transfusion data for 5,744 non-emergency CABG procedures (Jan 2008 - Jun 2011) at 12 facilities.
- Comparison of transfusion frequency, amount, components, and timing among surgeons and institutions.
- Application of multilevel mixed-effect models and intraclass correlation coefficients to quantify variation sources.
Main Results:
- Significant differences in transfusion practices were found among facilities, but were more consistent among surgeons within the same facility.
- The variance in red blood cell transfusion rates attributed to hospitals (0.82) was more than double that attributed to surgeons (0.35).
- Hospital effect explained 70% of the variation in transfusion rates, while surgeons accounted for 30%.
Conclusions:
- The hospital environment is a more significant determinant of blood utilization in cardiac surgery than individual surgeon preference.
- System-level interventions targeting hospital practices may be more effective in reducing blood product usage.
- Understanding institutional variations is crucial for standardizing and optimizing transfusion protocols in cardiac surgery.
Background:
In our effort to reduce the use of blood products in cardiac operations in a health care system, we noted variations in transfusion practices among facilities. Interestingly, surgeons practicing at the same hospital had similar transfusion rates. We sought to quantitate the contribution of hospital influence on individual surgeons' transfusion practices.
Methods:
Blood transfusion data for coronary artery bypass graft operations at 12 Providence Health & Services facilities between January 2008 and June 2011 were reviewed. Frequency of perioperative blood transfusion, amount of transfusion, components transfused, and timing of transfusions were compared. Variation among surgeons at the same institution vs between institutions was computed based on multilevel mixed-effect logistic and linear regression models. Intraclass correlation coefficients were calculated.
Results:
A total of 5,744 nonemergency first-time coronary artery bypass graft procedures were performed by 42 not-low volume (n>30 in 2.5 years) surgeons at 12 Providence Health & Services hospitals during the 3.5-year study period. Frequency, amount, timing, and blood component usage were different among facilities but relatively similar for surgeons within a facility. The variance of red blood cell transfusion rate among hospitals (.82) is more than two times that among surgeons practicing within the same hospital (.35). Thus, surgeons contribute 30% to the variation, and 70% of the total variation can be explained by the hospital effect.
Conclusions:
In our multihospital system, the hospital that a surgeon practices at plays a larger role in determining blood utilization than the individual surgeon's preference.
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