Restrictive blood transfusion practices are associated with improved patient outcomes.

Abstract:

BACKGROUND:Blood transfusion has been cited as one of the five most overutilized therapeutic procedures in the United States. We assessed the impact of clinical decision support at computerized physician order entry and education on red blood cell (RBC) transfusions and clinical patient outcomes at our institution. STUDY DESIGN AND METHODS:Clinical patient outcomes and RBC transfusions were assessed before and after implementation of a best practice alert triggered for transfusions when the hemoglobin level was higher than 7 g/dL for all inpatient discharges from January 2008 through December 2013. Retrospective clinical and laboratory data related to RBC transfusions were extracted: case-mix complexity, patient discharges and selected surgical volumes, and patient outcomes (mortality, 30-day readmissions, length of stay). RESULTS:There was a significant improvement in RBC utilization as assessed by RBC units transfused per 100 patient-days-at-risk. Concurrently, hospital-wide clinical patient outcomes showed improvement (mortality, p = 0.034; length of stay, p = 0.003) or remained stable (30-day readmission rates, p = 0.909). Outcome improvements were even more pronounced in patients who received blood transfusions, with decreased mortality rate (55.2 to 33.0, p < 0.001), length of stay (mean, 10.1 to 6.2 days, p < 0.001), and 30-day readmission rate (136.9 to 85.0, p < 0.001). The mean number of units transfused per patient also declined (3.6 to 2.7, p < 0.001). Acquisition costs of RBC units per 1000 patient discharges decreased from $283,130 in 2009 to $205,050 in 2013 with total estimated savings of $6.4 million and likely far greater impact on total transfusion-related costs. CONCLUSION:Improved blood utilization is associated with improved clinical patient outcomes.

journal_name

Transfusion

journal_title

Transfusion

authors

Goodnough LT,Maggio P,Hadhazy E,Shieh L,Hernandez-Boussard T,Khari P,Shah N

doi

10.1111/trf.12723

subject

Has Abstract

pub_date

2014-10-01 00:00:00

pages

2753-9

issue

10 Pt 2

eissn

0041-1132

issn

1537-2995

journal_volume

54

pub_type

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