Reducing Iatrogenic Blood Losses in Premature Infants.

Area of Science:

• Neonatal Medicine
• Implementation Science
• Healthcare Quality Improvement

Background:

• Iatrogenic blood loss from frequent laboratory testing contributes to anemia of prematurity.
• Blood transfusions are often necessary for premature infants due to blood loss.
• Reducing unnecessary laboratory tests is a key strategy to minimize iatrogenic blood loss.

Purpose of the Study:

• To decrease iatrogenic blood losses in very low birth weight infants.
• To implement strategies aimed at reducing repetitive laboratory testing.
• To evaluate the effectiveness of an implementation science approach in a neonatal intensive care unit setting.

Main Methods:

• Qualitative interviews using the Consolidated Framework for Implementation Research to identify barriers and facilitators.
• Development and deployment of targeted implementation strategies, including education and revised order sets.
• Comparison of laboratory tests, blood volume drawn, and charges before and after implementation using statistical models.

Main Results:

• An 18.5% reduction in laboratory tests and a 17% decrease in blood volume drawn per kilogram were observed.
• Significant reduction in overall laboratory charges by $290,328.
• No significant difference in the number of blood transfusions required; no adverse events reported.

Conclusions:

• An implementation science framework effectively reduced laboratory testing and associated blood loss in premature infants.
• This approach led to significant cost savings without compromising patient safety or transfusion rates.
• Combining qualitative and quantitative methods is valuable for successful implementation in clinical settings.