Patient safety intervention to reduce unnecessary red blood cell utilization.

OBJECTIVES: To measure the impact of a local patient safety intervention and a national guideline to reduce unnecessary red blood cell (RBC) transfusions in the Department of Medicine of an academic medical center.

STUDY DESIGN: This was a retrospective, pre-post study.

METHODS: In May 2013, a clinical practice guideline, modeled after the 2012 AABB recommendations for RBC use, was implemented with the goal of decreasing unnecessary RBC transfusions. This was done using a previously developed model for change management in the Department of Medicine that included academic safety conferences, e-mail safety alerts, and feedback to providers on global blood product utilization. Data regarding the utilization of RBC products were obtained for the time before the AABB guideline, after the AABB guideline but before the local intervention, and after the local intervention (January 2011 through March 2014).

RESULTS: Blood product use started to decline after the AABB guideline, but dropped much further after the focused, local interventions were implemented. The proportion of patients receiving a transfusion decreased from 12.6% prior to the AABB guideline to 8.8% after the intervention (P < .001). The percent of total blood use with a hemoglobin level above 8 g/dL decreased from 20.2% to 12.4%; the total units of RBCs transfused per 100 discharges also decreased from 33.4 to 21.7. The direct RBC costs per discharge dropped from $61.60 to $39.70.

CONCLUSIONS: Passive adoption of restrictive transfusion guidelines was shown to reduce blood product use on general medicine floors of an academic medical center, but the effect was greatly improved after a local, targeted intervention to improve patient safety was implemented.