How do I audit intraoperative blood component utilization in cardiac surgery?

Area of Science:

• Anesthesiology
• Transfusion Medicine
• Healthcare Quality Improvement

Background:

• Patient blood management programs aim to optimize transfusions.
• Cardiac surgery exhibits high variability in blood product utilization.
• Benchmarking revealed higher-than-expected intraoperative blood use in cardiac procedures.

Purpose of the Study:

• To implement and evaluate provider-specific audits with feedback for intraoperative blood utilization in cardiac surgery.
• To reduce variability and improve the appropriateness of blood product transfusions.

Main Methods:

• Retrospective analysis of transfusion data for 2242 cardiac surgery patients (July 2016-July 2018).
• Implementation of audits with feedback using rank-order bar graphs comparing providers.
• Data collected from electronic medical records for red blood cells, plasma, platelets, and cryoprecipitate.

Main Results:

• Significant decrease in intraoperative red blood cell (RBC) use (1.9 to 1.2 units/patient; p=0.0004).
• Significant decrease in intraoperative plasma (1.8 to 1.2 units/patient; p=0.0038) and platelet (PLT) (0.7 to 0.4 units/patient; p<0.0001) utilization.
• No significant change in cryoprecipitate use; whole hospital plasma and PLT use also decreased significantly.

Conclusions:

• Provider-specific audits with feedback are effective for quality improvement in transfusion practices.
• Electronic medical record data can be leveraged for targeted interventions.
• Future efforts will extend feedback audits to non-operating room transfusions.