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Reducing Iatrogenic Blood Losses in Premature Infants
Megha Sharma1, Emily Bowman2, Feng Zheng3
1Department of Pediatrics, Division of Neonatology.
Insights
Reducing iatrogenic blood loss in premature infants is crucial. An implementation science approach successfully decreased laboratory tests and blood volume drawn, lowering costs without increasing transfusions.
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.
Objective:
Iatrogenic blood losses from repetitive laboratory testing are a leading cause of anemia of prematurity and blood transfusions. We used an implementation science approach to decrease iatrogenic blood losses during the first 3 postnatal weeks among very low birth weight infants.
Methods:
We performed qualitative interviews of key stakeholders to assess implementation determinants (ie, barriers and facilitators to reducing iatrogenic blood losses), guided by the Consolidated Framework for Implementation Research. Next, we selected implementation strategies matched to these implementation determinants to de-implement excess laboratory tests. The number of laboratory tests, amount of blood taken (ml/kg), and laboratory charges were compared before and after implementation using quasi-Poisson and multi-variable regression models.
Results:
Qualitative interviews with 14 clinicians revealed implementation-related themes, including provider-specific factors, recurring orders, awareness of blood loss and cost, and balance between over- and under-testing. Implementation strategies deployed included resident education, revised order sets, blood loss and cost awareness, audit and feedback, and the documentation of blood out. There were 184 and 170 infants in the pre- and postimplementation cohorts, respectively. There was an 18.5% reduction in laboratory tests (median 54 [36 - 80] versus 44 [29 - 74], P = .01) in the first 3 postnatal weeks, a 17% decrease in blood taken (mean 18.1 [16.4 - 20.1] versus 15 [13.4 - 16.8], P = .01), and an overall reduction of $290 328 in laboratory charges. No difference was noted in the number of blood transfusions. Postimplementation interviews showed no adverse events attributable to implementation strategies.
Conclusions:
An implementation science approach combining qualitative and quantitative methods reduced laboratory tests, blood loss, and charges.
