Patient safety intervention to reduce unnecessary red blood cell utilization

Area of Science:

• Healthcare Management
• Patient Safety
• Transfusion Medicine

Background:

• Unnecessary red blood cell (RBC) transfusions pose risks and increase healthcare costs.
• Academic medical centers face challenges in optimizing blood product utilization.
• Existing national guidelines provide a framework for transfusion practices.

Purpose of the Study:

• To evaluate the impact of a national guideline and a local patient safety intervention on reducing unnecessary RBC transfusions.
• To assess changes in RBC utilization and associated costs within an academic medical center's Department of Medicine.

Main Methods:

• Retrospective, pre-post study design analyzing RBC utilization data from January 2011 to March 2014.
• Implementation of a clinical practice guideline based on 2012 AABB recommendations for RBC use.
• Application of a change management model including safety conferences, alerts, and provider feedback.

Main Results:

• RBC use declined after the national guideline and dropped significantly further after local interventions.
• Proportion of patients receiving transfusions decreased from 12.6% to 8.8% (P < .001).
• RBC units transfused per 100 discharges fell from 33.4 to 21.7, with direct costs decreasing from $61.60 to $39.70 per discharge.

Conclusions:

• Passive adoption of restrictive transfusion guidelines can reduce RBC use in academic medical centers.
• Targeted, local patient safety interventions substantially enhance the effectiveness of national guidelines.
• Optimizing RBC transfusion practices improves patient safety and reduces healthcare expenditures.