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Standardized Implementation of Evidence-based Guidelines to Decrease Blood Transfusions in Pediatric Intensive Care

Sheila J Hanson1,2, Erin B Owen3, Mark J McDonald3

  • 1Department of Pediatric Critical Care, Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI.

Pediatric Quality & Safety
|October 4, 2019
PubMed

Insights

A quality improvement initiative in pediatric intensive care units (PICUs) successfully reduced red blood cell (RBC) transfusions outside guideline thresholds. However, the total number of transfusions did not decrease, highlighting system complexity.

Area of Science:

  • Pediatric critical care medicine
  • Implementation science
  • Quality improvement in healthcare

Background:

  • Red blood cell (RBC) transfusions carry risks, yet practices vary widely.
  • Current transfusion guidelines are not consistently followed in pediatric intensive care units (PICUs).

Purpose of the Study:

  • To implement and assess a standardized quality improvement strategy to reduce RBC transfusions in PICUs.
  • To achieve a sustainable decrease in RBC transfusion rates and adherence to hemoglobin thresholds.

Main Methods:

  • A 16-month prospective, multicenter study involving 5 PICUs.
  • Implementation of a standardized plan including education, bedside tools, real-time reminders, and feedback.
  • Data collection across pre-implementation, post-implementation, and post-stabilization phases.

Main Results:

  • Transfusions per 1,000 admissions significantly decreased from baseline (209.6) to 199.8 (Phase II) and 195.8 (Phase III) (P < 0.05).
  • Transfusions outside hemoglobin threshold guidelines decreased from 81% to 74% (P < 0.05).
  • Factors like co-management and requesting provider service were associated with guideline-exceeding transfusions.

Conclusions:

  • Multicenter collaboration using implementation science principles can reduce RBC transfusions outside guideline thresholds.
  • The total number of RBC transfusions was not decreased, indicating challenges in complex PICU systems.
  • Targeted educational initiatives may have limited impact in multifaceted care environments.
Abstract

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