Community-Based Hospitals Benefit From Restrictive Transfusion Practices

Hill, James L. Jr MD, MBA, CPE, FASA, FACHE; Dawson, Jennifer L. MBA, MSN, RN, NE-BC; Ramic, Meghan MSN, RN, CPHQ; Manzo, Julia DO; Pronovost, Peter J. MD, PhD

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Journal for Healthcare Quality 45(2):p 117-123, March/April 2023. | DOI: 10.1097/JHQ.0000000000000376

Blood availability was uncertain during the COVID-19 pandemic, yet transfusion remained a common and sometimes necessary procedure. Substantial work on optimizing transfusion practices is centered in tertiary hospitals as high utilizers of blood while the care delivered in smaller community hospitals comprises more than half the nation’s transfusions. Improving transfusion practices in community hospitals represents a substantial opportunity to enhance patient safety and the availability of blood resources. Clinical specialists developed a dashboard to retrospectively examine transfusion events including an evidence-based analysis of the patient’s clinical situation at the time of transfusion to more accurately identify how appropriately blood was used. The compiled data were discussed and shared with transfusing providers. It was hypothesized that the data provided and communication strategies used would educate providers to current evidence-based practice, leading to more appropriate transfusion with an overall reduction in packed red blood cell utilization. There was an 11% increase in transfusion appropriateness (p = <.001) and a 14% decrease in the units transfused (p = .004). Improvement in transfusion practices demonstrates a significant impact on patient safety and the availability of blood resources. Although absolute opportunity may be less in a community hospital, fewer resources are needed to achieve meaningful change.

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