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Decreasing packed red blood cell (pRBC) transfusions in neonates through quality improvement
Valerie Elberson1,2, Kavya Rao3,4, Sheetal Chepuri3,4
1Jacobs School of Medicine, Department of Pediatrics, SUNY at Buffalo, Buffalo, NY, USA. velberson@upa.chob.edu.
Objective:
Using a quality improvement (QI) framework, we aimed to reduce the number of transfusions of packed red blood cells (pRBC) through adoption of evidence based more restrictive transfusion thresholds.
Methods:
A SMART aim was developed to decrease pRBC transfusions in infants less than 35 weeks gestation at birth by approximately 25 percent from the baseline rate of 28/1000 patient days by 12/31/2024 through implementation of a transfusion protocol with more restrictive thresholds. Five sequential Plan-Do-Study-Act cycles incorporated guidelines to decrease transfusions. Statistical Process Control charts (QI Macros SPC Software for Microsoft Excel) were used to track time-ordered data.
Results:
pRBC transfusions decreased from 28/1000 patient days to 18.3/1000 patient days below the target of 21/1000 patient days over a 16-month period.
Conclusion:
A transition to more restrictive transfusion thresholds was done successfully in our unit with a robust framework leading to fewer pRBC transfusions.
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