A comprehensive Choosing Wisely quality improvement initiative reduces unnecessary transfusions in an Academic Department of Surgery - 15/09/17

Doi : 10.1016/j.amjsurg.2017.06.020

Caitlin W. Hicks ^a,^⁎ , Jing Liu ^b, William W. Yang ^b, Sandra R. DiBrito ^a, Daniel J. Johnson ^b, Alexandra Brito ^c, Robert S.D. Higgins ^a, Steven M. Frank ^b,^d, Elizabeth C. Wick ^e
^a Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
^b Johns Hopkins Health System Blood Management Program, Baltimore, MD, USA
^c Department of Surgery, University of California San Diego, San Diego, CA, USA
^d Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
^e Department of Surgery, University of California San Francisco, San Francisco, CA, USA

^∗Corresponding author. 600 N. Wolfe Street, Halsted 668, Baltimore, MD 21287, USA.600 N. Wolfe StreetHalsted 668BaltimoreMD21287USA

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.

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Highlights

•	Implementation of a comprehensive Choosing Wisely campaign significantly improved transfusion practices in an Academic Department of Surgery.

Le texte complet de cet article est disponible en PDF.

Keywords : Transfusion medicine, Quality improvement, Choosing Wisely, Resident initiative

Plan

Educational intervention

Transfusion report cards

Statistical analysis

Results

Defining the problem

Change in transfusion compliance pre- vs. post-intervention

Change in blood product use pre- vs. post-intervention

Improvement in transfusion knowledge pre- vs. post-intervention

Estimated cost benefits

Discussion

Conclusions

Disclosures

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Vol 214 - N° 4

P. 571-576 - octobre 2017 Retour au numéro

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A comprehensive Choosing Wisely quality improvement initiative reduces unnecessary transfusions in an Academic Department of Surgery - 15/09/17

Abstract

Background

Methods

Results

Conclusions

Highlights

Plan

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