Reducing Unnecessary Transfusions of RBCs in Inpatients Admitted Across Niagara Health Community Hospitals.

IF 1.2 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES
Yazan Abu Yousef, Ashis Bagchee-Clark, Krista Walters, Mary Green, Mary Salib, Ankush Chander, Madelyn P Law, Mohammad Refaei
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Abstract

Background and objectives: Blood products are scarce resources. Audits on the use of red blood cells (RBCs) in tertiary centers have repeatedly highlighted inappropriate use. Earlier retrospective audit at our local community hospitals has demonstrated that only 85% and 54% of all requests met Choosing Wisely Canada guidelines for pre-transfusion hemoglobin (Hb) of 80 g/L or less and single unit, respectively.We sought to improve RBC utilization by 15% over a period of 12 months (meeting Choosing Wisely Canada criteria of pre-transfusion Hb ≤80g/L by >80% and single-unit transfusion by >65%).

Methods: Following repeated PDSA (Plan-Do-Study-Act) cycles, we implemented educational strategies, prospective transfusion medicine (TM) technologist-led screening of orders, and an RBC order set.

Results: The 3-month median percentages of appropriate RBC use for pre-transfusion Hb and single unit (September-November 2021) across all 3 hospitals were 90% and 71%, respectively. Overall, the rate of appropriate RBCs based on pre-transfusion Hb remained above target (>80%), with minimal improvement across all hospitals (median percentage at pre- and post-technologist screening periods of 87% and 90%, respectively). The median percentage of appropriate RBCs based on single-unit transfusion orders has improved across all Niagara Health hospitals with sustained targets (3-month median percentage at pre- and post-technologist screening and most recent time periods of 54%, 56%, and 71%, respectively).

Conclusions: We have taken a collaborative, multifaceted approach to optimizing utilization of RBCs across the Niagara Health hospitals. The rates of appropriate RBC use were comparable with the provincial and national accreditation benchmark standards. In particular, the TM technologist-led screening was effective in producing sustained improvement with respect to single-unit transfusion. One of the balancing outcomes was increasing workload on technologists. Local and provincial efforts are needed to facilitate recruitment and retention of laboratory technologists, especially in community hospitals.

减少尼亚加拉健康社区医院住院病人不必要的红细胞输注。
背景和目标:血液制品是稀缺资源。对三级医疗中心红细胞(RBC)使用情况的审计多次强调了使用不当的问题。我们试图在 12 个月内将红细胞使用率提高 15%(符合加拿大选择明智输血标准(Choosing Wisely Canada)输血前血红蛋白(Hb)≤80g/L 的比例>80%,符合单单位输血标准的比例>65%):方法:在反复的 PDSA(计划-实施-研究-行动)循环之后,我们实施了教育策略、由输血医学(TM)技术人员主导的前瞻性订单筛选和 RBC 订单集:所有 3 家医院输血前 Hb 和单一单位(2021 年 9 月至 11 月)RBC 合理使用率的 3 个月中位数分别为 90% 和 71%。总体而言,基于输血前 Hb 的适当 RBC 使用率仍高于目标值(>80%),所有医院的改善幅度都很小(技术专家筛查前和筛查后的中位百分比分别为 87% 和 90%)。尼亚加拉医疗中心的所有医院根据单次输血指令获得适当红细胞的百分比中位数都有所提高,并持续保持在目标水平上(技术专家筛查前后和最近 3 个月的百分比中位数分别为 54%、56% 和 71%):我们采取了多方面的合作方法来优化尼亚加拉医疗中心各家医院对 RBC 的使用。RBC 的合理使用率与省级和国家级评审基准标准相当。特别是,以输血技术专家为主导的筛查有效地持续改善了单单位输血率。平衡结果之一是增加了技师的工作量。地方和省级需要努力促进实验室技术人员的招聘和留任,尤其是在社区医院。
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来源期刊
Quality Management in Health Care
Quality Management in Health Care HEALTH CARE SCIENCES & SERVICES-
CiteScore
1.90
自引率
8.30%
发文量
108
期刊介绍: Quality Management in Health Care (QMHC) is a peer-reviewed journal that provides a forum for our readers to explore the theoretical, technical, and strategic elements of health care quality management. The journal''s primary focus is on organizational structure and processes as these affect the quality of care and patient outcomes. In particular, it: -Builds knowledge about the application of statistical tools, control charts, benchmarking, and other devices used in the ongoing monitoring and evaluation of care and of patient outcomes; -Encourages research in and evaluation of the results of various organizational strategies designed to bring about quantifiable improvements in patient outcomes; -Fosters the application of quality management science to patient care processes and clinical decision-making; -Fosters cooperation and communication among health care providers, payers and regulators in their efforts to improve the quality of patient outcomes; -Explores links among the various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the role and responsibilities of organizational governance in ongoing quality management.
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