Evaluating the effects of a hospital utilisation improvement program on platelet transfusions: A pre-post study.

Background: Annually millions of platelet concentrate (PC) are transfused worldwide. The decision regarding PC transfusion is often complex; therefore, the implementation of a hospital programme designed to streamline and facilitate the decision-making process is beneficial. Such a programme helps standardise transfusion practices, ensures that PCs are used appropriately, while also optimising patient outcomes.

Objectives: The study aimed to analyse the impact of a new hospital utilisation improvement programme on PC transfusions.

Methods/materials: We performed a retrospective analysis of all PC transfusions in adult patients hospitalised in our large academic medical centre. The analysed time covered 12-month periods before and after the introduction of the program, which was based on the most recent clinical practice guidelines from the Association for the Advancement of Blood and Biotherapies. Indications for PC transfusion were divided into prophylactic and therapeutic. The new program was made available on the hospital intranet, obligatory e-learning was required from all clinical and laboratory personnel, and a computerised physician order entry was modified.

Results: The transfusion rate in the whole analysed period was 0.17%. The median pre-transfusion platelet count before and after implementation of the programme was 28 (IQR 15.0-50.0) and 24 (IQR 12.0-42.0) × 10⁹/L, respectively. Percentage of therapeutic transfusions increased from 46.7% to 57.7%. Overall the appropriateness of transfusions went up from 48.4% to 59.9%, and was higher for therapeutic (70.2% vs. 60.0%) than prophylactic (45.8% vs. 38.3%) transfusions.

Conclusion: Simple hospital utilisation improvement programme, adjusted to the local population and backed by e-learning and modification of a computerised physician order entry, can lead to a more restrictive use of PC transfusions in patients with thrombocytopenia.