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06-2022

New paper from university hospitals examines transfusion use and suitability: thinking differently in a tertiary academic medical center

Newswise — Cleveland In a new paper, University Hospitals (UH) researchers detail how they used data via a dashboard to reduce the use of packed red-blood cell (pRBC) transfusions and platelets with an increase in appropriate transfusions. used.

Their paper, “Transfusion Utilization and Appropriateness: Thinking Differently at a Tertiary Academic Medical Center,” appears in the July/August 2022 issue of the Physician Leadership Journal. (DOI: https://doi:10.55834/plj.1146877267)

Lead author Jennifer Dawson, MBA, MSN, RN said, “We hypothesized that the use of evidence-based transfusion algorithms considering patient specific criteria will increase awareness that will reduce the use of PRBC and platelets while improving appropriate use.” ” Dawson is an operations engineer and high-reliability medicine strategist at UH.

Researchers developed a transfusion suitability algorithm (TAA) to analyze blood transfusions for all adult patients at a tertiary academic medical center. A multidisciplinary expert panel of over 30 participants was assembled to review the current literature and existing practice guidelines to define diagnostic criteria for appropriate transfusion; With evidence suggesting that such a team approach enhances patient safety.

All collected data was then aggregated into a dashboard presenting the suitability scores derived from the TAA as well as the lab thresholds for each blood component. The dashboard was built over the course of a year starting in 2017, then tested and refined in 2018. It was implemented in 2019. The app contained multiple reports and allowed the review of provider or patient lists for comparison or further study. A consolidated report for each patient encounter showed individual transfusion data over time, including each provider who prescribed treatment.

The authors found reductions in PRBC and platelet transfusions: a total of 46,835 PRBC transfusions occurred, which decreased from 24,607 to 22,228 between groups, and 15,132 platelet transfusions, decreased from 7,989 to 7,143 between groups. The transfusion average of PRBC decreased from 2,051 (±109) to 1,852 (±89) units per month (p = < .001), with a mean difference of 198. [CI = 114, 283], Platelet transfusions decreased from an average of 665 (± 105) to 595 (± 47) units per month (p = .025) with a mean difference of 71. [CI = 13, 140],

There has been an increase in the measure of suitability for both PRBC and platelets. The appropriate percentage of pRBC increased from an average of .67 (±.03) to .81 (±.02) per month (p = <.001), with a mean difference of -.14 [CI = − .16, − .12], The appropriate percentage of platelets increased from an average of .69 (± .04) to an average of .73 (± .03) per month (p = < .022) - with a mean difference of .04. [CI = − .07, − .01],

The types of hospital patient encounters remained constant, with an average of 41 percent surgical, 26 percent medical, 18 percent oncology and 15 percent obstetric. Patient outcomes remained stable while transfusions decreased. The 12-month direct cost of PRBC and platelet transfusion is reduced by $2.5 million.

Principal investigator James Hill, Jr., MD, chief operating officer and critical care anesthesiologist at UH Parma Medical Center and assistant professor, said, “Our findings show significant results in post-transfusion and cost savings after implementation of the dashboard without negatively impacting patient outcomes. shows a lack.” for the School of Medicine at Case Western Reserve University. Dr. Hill previously served as systems medical director of Transfusion Services and Blood Management and was chief of trauma anesthesiology at UH Cleveland Medical Center.

“Healthcare does great, yet it can be too much if we make visible and eliminate defects in value. Our intervention demonstrates this, improving quality and reducing the cost of care,” co- said author Peter Pronovost, MD, PhD, chief clinical transformation officer at UH and professor in the Schools of Medicine, Nursing and Management at Case Western Reserve University.

Other authors on the paper are Craig Schwab, MBA; Richard K. Jordan, MD; Keith A. Andrews, DO, and Zill R. Patel, DO.

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About University Hospitals / Cleveland, Ohio Founded in 1866, University Hospitals serves patients through an integrated network of more than 20 hospitals (including five joint ventures), more than 50 health centers and outpatient facilities, and more than 200 physician offices in 16 counties throughout northern Ohio. meets the needs of. The system’s flagship quaternary care is affiliated with the Academic Medical Center, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Northeast Ohio Medical University, Oxford University, and the Technion Israel Institute of Technology. The main campus also includes the UH Rainbow Babies & Children’s Hospital, which is ranked among the top children’s hospitals in the country; UH McDonald Women’s Hospital, Ohio’s only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the country, with over 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is one of the top performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH also has 19 clinical care delivery and research institutes. UH is one of the largest employers in Northeast Ohio with over 30,000 employees. LinkedIn, Facebook and . follow uh on Twitter, For more information visit UHhospitals.org.

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