Reducing Adverse Events Associated with Pediatric Cardiac Catheterization: A Quality Improvement Project Focusing on...

Area of Science:

• Pediatric Cardiology
• Quality Improvement Science
• Transfusion Medicine

Background:

• Red blood cell transfusion (RBCT) is common after pediatric cardiac catheterization.
• Reducing unnecessary transfusions is crucial for patient safety and resource management.

Purpose of the Study:

• To describe interventions and outcomes of a quality improvement (QI) project aimed at reducing RBCT within 72 hours of pediatric cardiac catheterization.
• To evaluate the impact of standardized transfusion criteria and a "hard stop" policy on RBCT rates.

Main Methods:

• Utilized Plan-Do-Study-Act (PDSA) methodology for QI.
• Implemented interventions: intraprocedural adjustments, standardized transfusion criteria, and a "hard stop" requiring QI team consultation for elective post-catheterization RBCT.
• Monitored RBCT frequency, cases between transfusions (CBT), and length of stay (LOS).

Main Results:

• Standardized guidelines and the "hard stop" policy decreased RBCT frequency from 10% to 1.9% and increased CBT.
• Intraprocedural interventions did not significantly alter RBCT or CBT rates.
• Patients receiving RBCT were younger, smaller, had longer procedures, and had single ventricle physiology.

Conclusions:

• Programmatic adherence to standardized peri-procedural transfusion guidelines effectively reduced RBCT.
• The QI project successfully decreased RBCT rates without compromising patient care or increasing LOS.
• Younger age, lower weight, longer procedure duration, and single ventricle physiology are associated with increased RBCT risk.