Helen Jingshu Jin MSc (is Medical Student, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada), Tsan-Hua Tung PhD (is Department of Surgery, London Health Sciences Centre, London, Ontario), Sydney Selznick MD (is Resident Physician, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery, London Health Sciences Centre), Christine Cotton RN (is Patient Blood Management Program Coordinator, Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre), Madeline Lemke MD, MSc (is General Surgery Resident, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery, London Health Sciences Centre), Lily J. Park MD, MSc (is General Surgery Resident, Department of Surgery, McMaster University), Christopher C. Harle FRCA, FRCP (is Associate Professor, Schulich School of Medicine and Dentistry, and Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre), Bradley Moffat MD, MSc, MSc(QI), FRCSC, FACS (is Assistant Professor, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery, London Health Sciences Centre), Patrick Colquhoun MD, MSc, FRCSC, FACS, FASCRS (is Professor, Schulich School of Medicine and Dentistry, Western University, and Departments of Surgery and Oncology, London Health Sciences Centre), Terry Murray Zwiep MD, MSc, FRCSC (is Assistant Professor, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery London Health Sciences Centre. Please address correspondence to Terry Murray Zwiep)
{"title":"Improving the Treatment of Preoperative Anemia in Colorectal and Hepato-Pancreato-Biliary Patients: A Quality Improvement Initiative","authors":"Helen Jingshu Jin MSc (is Medical Student, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada), Tsan-Hua Tung PhD (is Department of Surgery, London Health Sciences Centre, London, Ontario), Sydney Selznick MD (is Resident Physician, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery, London Health Sciences Centre), Christine Cotton RN (is Patient Blood Management Program Coordinator, Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre), Madeline Lemke MD, MSc (is General Surgery Resident, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery, London Health Sciences Centre), Lily J. Park MD, MSc (is General Surgery Resident, Department of Surgery, McMaster University), Christopher C. Harle FRCA, FRCP (is Associate Professor, Schulich School of Medicine and Dentistry, and Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre), Bradley Moffat MD, MSc, MSc(QI), FRCSC, FACS (is Assistant Professor, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery, London Health Sciences Centre), Patrick Colquhoun MD, MSc, FRCSC, FACS, FASCRS (is Professor, Schulich School of Medicine and Dentistry, Western University, and Departments of Surgery and Oncology, London Health Sciences Centre), Terry Murray Zwiep MD, MSc, FRCSC (is Assistant Professor, Schulich School of Medicine and Dentistry, Western University, and Department of Surgery London Health Sciences Centre. Please address correspondence to Terry Murray Zwiep)","doi":"10.1016/j.jcjq.2025.06.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Preoperative anemia for patients undergoing major surgery is associated with increased postoperative morbidity and mortality, including increased requirement for perioperative blood transfusion, length of hospital stay, in-hospital mortality, and ICU admissions. In this quality improvement initiative, the authors describe measures implemented to promote preoperative anemia screening rates and increase uptake in hemoglobin optimizing interventions, with the goal of decreasing perioperative blood transfusion rates.</div></div><div><h3>Methods</h3><div>Change ideas implemented included establishing a new relationship between the Division of General Surgery and the center’s established Patient Blood Management (PBM) program; amending the center’s electronic health record to include prebuilt order sets for anemia screening bloodwork, PBM referrals, and oral iron prescriptions; modifying surgical consent packages to include anemia screening questions; and providing education to relevant care team members.</div></div><div><h3>Results</h3><div>A total of 1,444 patients were included. PBM referrals for anemic patients were increased to 24.6% from 0%. In patients with anemia (<em>n</em> = 754), preoperative treatment was independently associated with a decrease in perioperative blood transfusion (odds ratio 0.42, <em>p</em> = 0.007). Patients connected with the PBM program had decreased lengths of hospital stay (6.6 vs 9.7 days, <em>p</em> = 0.01), admissions to the ICU (1.1% vs 6.7%, p = 0.03), and in-hospital mortality (0% vs 4.3%, <em>p</em> = 0.04) compared to unreferred anemic patients.</div></div><div><h3>Conclusion</h3><div>The interventions described were successful in decreasing the perioperative blood transfusion rates and improving postoperative outcomes for anemic patients undergoing major surgery. The initiatives were easily incorporated into the existing surgical workflow and can be expanded into other centers and surgical fields.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 10","pages":"Pages 652-658"},"PeriodicalIF":2.4000,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725025001527","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
Preoperative anemia for patients undergoing major surgery is associated with increased postoperative morbidity and mortality, including increased requirement for perioperative blood transfusion, length of hospital stay, in-hospital mortality, and ICU admissions. In this quality improvement initiative, the authors describe measures implemented to promote preoperative anemia screening rates and increase uptake in hemoglobin optimizing interventions, with the goal of decreasing perioperative blood transfusion rates.
Methods
Change ideas implemented included establishing a new relationship between the Division of General Surgery and the center’s established Patient Blood Management (PBM) program; amending the center’s electronic health record to include prebuilt order sets for anemia screening bloodwork, PBM referrals, and oral iron prescriptions; modifying surgical consent packages to include anemia screening questions; and providing education to relevant care team members.
Results
A total of 1,444 patients were included. PBM referrals for anemic patients were increased to 24.6% from 0%. In patients with anemia (n = 754), preoperative treatment was independently associated with a decrease in perioperative blood transfusion (odds ratio 0.42, p = 0.007). Patients connected with the PBM program had decreased lengths of hospital stay (6.6 vs 9.7 days, p = 0.01), admissions to the ICU (1.1% vs 6.7%, p = 0.03), and in-hospital mortality (0% vs 4.3%, p = 0.04) compared to unreferred anemic patients.
Conclusion
The interventions described were successful in decreasing the perioperative blood transfusion rates and improving postoperative outcomes for anemic patients undergoing major surgery. The initiatives were easily incorporated into the existing surgical workflow and can be expanded into other centers and surgical fields.
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