Transfusing Wisely: Clinical Decision Support Improves Blood Transfusion Practices.

Area of Science:

• Healthcare Quality Improvement
• Transfusion Medicine
• Patient Safety

Background:

• Red blood cell (RBC) transfusions carry risks and costs, with evidence of overuse impacting patient care quality and value.
• Improving transfusion practices is a critical objective for healthcare systems.
• A quality improvement project aimed to reduce unnecessary blood product exposure and associated costs.

Purpose of the Study:

• To evaluate the effectiveness of a quality improvement initiative in reducing red blood cell (RBC) transfusions.
• To decrease the incidence of multiunit RBC transfusions and transfusions for hemoglobin levels of 7 g/dL or higher.
• To assess the impact on healthcare costs and transfusion practices.

Main Methods:

• A prospective, pre-post study design was employed at an academic medical center.
• Interventions included provider education, a BestPractice Advisory (BPA), and enhancements to the computerized provider order entry system.
• The study included non-infant inpatients without gastrointestinal bleeding or recent surgery.

Main Results:

• Multiunit (≥2 units) RBC transfusions decreased significantly from 59.9% to 19.7% post-intervention (p < 0.0001).
• Transfusions for hemoglobin (Hb) ≥7 g/dL declined from 72.3% to 38.0% (p < 0.0001).
• Estimated annual cost savings reached $1,050,750.

Conclusions:

• The implemented interventions effectively reduced multiunit transfusions by 67.1% and transfusions for Hb ≥7 g/dL by 47.4%.
• The quality improvement project demonstrated substantial cost savings and improved transfusion appropriateness.
• The study highlights the potential for targeted interventions to optimize RBC transfusion practices.