Caitlin W Hicks1, Jing Liu2, William W Yang2, Sandra R DiBrito3, Daniel J Johnson2, Alexandra Brito4, Robert S D Higgins3, Steven M Frank5, Elizabeth C Wick6. 1. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: chicks11@jhmi.edu. 2. Johns Hopkins Health System Blood Management Program, Baltimore, MD, USA. 3. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. 4. Department of Surgery, University of California San Diego, San Diego, CA, USA. 5. Johns Hopkins Health System Blood Management Program, Baltimore, MD, USA; Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA. 6. Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
Abstract
BACKGROUND: We implemented a comprehensive Choosing Wisely initiative to reduce unnecessary transfusions in an Academic Department of Surgery. METHODS: We conducted a survey- and lecture-based educational intervention to increase awareness about published transfusion guidelines. Monthly transfusion reports were subsequently distributed to all faculty, fellows, residents, and mid-level practitioners. Blood utilization measures were compared pre- vs. post-intervention to assess effectiveness. RESULTS: 7994 blood product orders (5388 pre-intervention, 2606 post-intervention) were placed (07/2014-06/2016). Red blood cell (RBC) (45% vs. 55%; P < 0.001) and plasma (68% vs. 75%; P = 0.02) compliance improved post-intervention, with a corresponding 15% decrease in RBC utilization (0.47 ± 0.02 vs. 0.40 ± 0.02 units/patient; P = 0.01), and 24% decrease in plasma (0.25 ± 0.02 vs. 0.19 ± 0.02 units/patient; P = 0.06). These reductions translate into $125,558 in blood product acquisition cost avoidance (RBC = $114,386, plasma = $11,172). CONCLUSIONS: Implementation of a comprehensive Choosing Wisely campaign targeting individual providers at all levels significantly improved transfusion practices and decreased costs within the Department of Surgery.
BACKGROUND: We implemented a comprehensive Choosing Wisely initiative to reduce unnecessary transfusions in an Academic Department of Surgery. METHODS: We conducted a survey- and lecture-based educational intervention to increase awareness about published transfusion guidelines. Monthly transfusion reports were subsequently distributed to all faculty, fellows, residents, and mid-level practitioners. Blood utilization measures were compared pre- vs. post-intervention to assess effectiveness. RESULTS: 7994 blood product orders (5388 pre-intervention, 2606 post-intervention) were placed (07/2014-06/2016). Red blood cell (RBC) (45% vs. 55%; P < 0.001) and plasma (68% vs. 75%; P = 0.02) compliance improved post-intervention, with a corresponding 15% decrease in RBC utilization (0.47 ± 0.02 vs. 0.40 ± 0.02 units/patient; P = 0.01), and 24% decrease in plasma (0.25 ± 0.02 vs. 0.19 ± 0.02 units/patient; P = 0.06). These reductions translate into $125,558 in blood product acquisition cost avoidance (RBC = $114,386, plasma = $11,172). CONCLUSIONS: Implementation of a comprehensive Choosing Wisely campaign targeting individual providers at all levels significantly improved transfusion practices and decreased costs within the Department of Surgery.
Authors: Jori E May; Patrick C Irelan; Kailee Boedeker; Emily Cahill; Steven Fein; David A Garcia; Lisa K Hicks; Janice Lawson; Ming Y Lim; Colleen T Morton; Anita Rajasekhar; Satish Shanbhag; Marc S Zumberg; Robert M Plovnick; Nathan T Connell Journal: Blood Adv Date: 2020-09-22
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