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Blood component utilization before and after implementation of good transfusion practice measures in a pediatric
Ashish Sharma1, Karthi Nallasamy1, Ashish Jain2
1Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Pediatric emergency departments frequently use red blood cells but have poor utilization. Simple interventions can improve blood component transfusion practices.
Area of Science:
- Pediatric Emergency Medicine
- Transfusion Medicine
- Healthcare Quality Improvement
Background:
- Blood component utilization in pediatric emergency departments (EDs) is often suboptimal.
- Packed red cells (PRBCs) demonstrate particularly low utilization rates.
Purpose of the Study:
- To determine blood component utilization patterns in a pediatric ED.
- To compare utilization rates before and after implementing simple transfusion practice interventions.
Main Methods:
- Prospective pre/post interventional study over 14 months.
- Intervention included education on transfusion triggers and supervision by a designated 'transfusion resident'.
- Data collected during pre-intervention, intervention, and post-intervention phases.
Main Results:
- Pre-intervention: 51.5% overall utilization; PRBCs 30%, Platelet Concentrates (PC) 72%, Fresh Frozen Plasma (FFP) 96%.
- Post-intervention: 14% reduction in requests; overall utilization increased to 56%, PRBC utilization to 37.4%.
- Improvements were not statistically significant, but trends indicated better utilization.
Conclusions:
- PRBCs are the most requested yet poorly utilized blood components in the pediatric ED.
- Targeted education for early-career providers can enhance blood component utilization and transfusion practices.
Objectives:
We aimed to determine the pattern of blood component utilization in pediatric Emergency Department (ED) and compare the utilization rate before and after the implementation of simple good transfusion practice measures.
Material And Methods:
This was a prospective pre/post interventional study conducted between February 2015 and April 2016. The study included 3 phases [1] Pre-intervention phase (6 weeks) consisting of baseline data collection [2] Intervention phase (3 months) involving education on transfusion triggers and periodic mailers about good practice and designated 'transfusion resident' for supervision. [3] Post- intervention phase (6 weeks) collecting data while continuing interventions.
Results:
During pre-intervention, 379 blood components [Packed red cells(PRBC) - 227, Platelet concentrate(PC) - 78, Fresh Frozen Plasma(FFP) - 74] were requested for 280 children; 195 were transfused with an overall utilization rate of 51.5 %. PRBC had the poorest utilization rate (30 %) followed by PC (72 %) and FFP (96 %). About 79 % of the requisitions sent by residents in first training year were not utilized before intervention. Indications such as anticipated surgery, congenital heart disease, pneumonia and sepsis had lower utilization rate. Post intervention, there was 14 % reduction in blood component requests (325 requests in 258 patients). Both overall utilization rate (56 %) and PRBC utilization (37.4 %) showed improvement but the difference was statistically not significant.
Conclusions:
Red blood cells were the most frequently requested blood components yet poorly utilized in ED. Simple interventions targeting providers in early stages of training could potentially improve the blood component utilization and transfusion practices in busy emergency departments.
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