Related Experiment Video
Updated: Apr 25, 2026
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
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.
Insights
This quality improvement study successfully reduced packed red blood cell (pRBC) transfusions in premature infants by implementing more restrictive transfusion thresholds, exceeding targets.
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.
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.
Related Concept Videos
02:45Blood Transfusion and Agglutination
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...
01:19Rh Blood Group