Improving red cell transfusion in the elective surgical setting: an improvement collaborative with evaluation.

Area of Science:

• Healthcare Quality Improvement
• Health Services Research
• Patient Safety

Background:

• Approximately 30% of red cell transfusions in stable adult patients were inappropriate in NSW hospitals.
• The Australian government spent $878.8 million on blood products and plasma in 2009-2010.
• The Clinical Excellence Commission (CEC) initiated the Blood Watch (BW) program to address transfusion overuse.

Purpose of the Study:

• To evaluate the effectiveness of the BW program in reducing inappropriate red cell transfusions.
• To estimate the potential cost savings associated with the BW program.
• To assess the impact of BW across five elective surgical groups.

Main Methods:

• Utilized deterministic linkage of four administrative databases to develop process and outcome indicators.
• Employed three-level logistic and linear regression to analyze trends in indicators.
• Applied quadratic regression modeling to estimate avoided red cell transfusions.

Main Results:

• A 27.4% reduction in blood usage was observed following the BW program's implementation.
• Reductions in blood usage were consistent across all five studied elective surgical groups.
• The program generated annual cost savings exceeding $8.5 million.

Conclusions:

• The BW program, utilizing collaborative improvement methods at scale, significantly decreased blood usage.
• Consistent reductions in transfusion rates were achieved across diverse surgical patient groups.
• The initiative demonstrated significant cost-saving benefits for the healthcare system.