Decreasing packed red blood cell (pRBC) transfusions in neonates through quality improvement

Area of Science:

• Neonatal Medicine
• Pediatric Hematology
• Quality Improvement Science

Background:

• Premature infants (less than 35 weeks gestation) often require packed red blood cell (pRBC) transfusions.
• Evidence-based guidelines suggest more restrictive transfusion thresholds may be appropriate.
• Reducing unnecessary transfusions is crucial for patient safety and resource management.

Purpose of the Study:

• To decrease pRBC transfusions in infants less than 35 weeks gestation by approximately 25% using a quality improvement framework.
• To implement a transfusion protocol with more restrictive thresholds.
• To achieve a target transfusion rate below 21/1000 patient days.

Main Methods:

• A SMART aim was established for reducing pRBC transfusions.
• Five sequential Plan-Do-Study-Act (PDSA) cycles were utilized to implement changes.
• Statistical Process Control (SPC) charts were employed to monitor transfusion data over time.

Main Results:

• pRBC transfusions decreased from a baseline of 28/1000 patient days to 18.3/1000 patient days.
• The achieved rate was below the target of 21/1000 patient days.
• The reduction was sustained over a 16-month period.

Conclusions:

• A quality improvement framework facilitated a successful transition to more restrictive transfusion thresholds.
• The implemented changes led to a significant and sustained decrease in pRBC transfusions.
• This approach demonstrates the effectiveness of evidence-based practice in neonatal care.