Transfusion practices vary worldwide given the diverse clinical situations necessitating transfusions. More than 1.32 million packed red blood cell (pRBC) units are transfused annually in the United States. Given the infectious and noninfectious risks associated with transfusion as well as data not showing superior outcome with liberal red blood cell transfusion, current guidelines support a restrictive strategy.
Using the latest guidelines and literature, we aimed to improve appropriateness of transfusions in the intensive care setting and lower the number of transfusions and associated costs.
In a mixed medical‐surgical intensive care setting in a community hospital, we created a hospital order set using the most recent literature and evidence‐based guidelines. Nursing staff, physicians, and allied health care workers were educated on the latest guidelines and order set usage. Multiple educational sessions and grand rounds for physicians and nurses helped increase awareness. Data were collected over 1 year (June 2011–May 2012) on all transfusions in the ICU. Five hundred seventy‐four units of pRBCs were transfused during the period. A 29% reduction (from 336 to 238 units) was observed while comparing data from the initial 6 months with data from the subsequent 6 months. This amounted to a reduction in cost of $63,210 (cost of transfusion is $645/unit, excluding administration costs). Moreover, mean transfusion rate in the corresponding periods reduced from 3 to 2 units per patient (mean, 5; from transfusion trials in critical care and trauma centers). Appropriateness of transfusion before the start of this project was 26%, and the rate improved in each quarter — 67.6%, 90%, 77%, and 77% (an average of 79%). Posttransfusion 28.38% of patients (65 of 229) developed acute kidney injury (AKI). Posttransfusion fluid overload incidence was 20%. All‐cause mortality was 16.6% (13%–25% in reported studies). There were no reported data on the incidence of AKI and fluid overload in other studies for comparison.
Using evidence‐based protocol‐driven transfusion order set leads to improved clinical practice and reduces associated health care costs.
To cite this abstract:Samavedam S, Vasudevan A, Eagen J, Kane M, Kurumilla S. Appropriate Rbc Transfusions in the Intensive Care Setting: A Quality Improvement Initiative. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 153. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/appropriate-rbc-transfusions-in-the-intensive-care-setting-a-quality-improvement-initiative/. Accessed November 18, 2019.