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. 2019 Oct;59(10):3058-3064.
doi: 10.1111/trf.15399. Epub 2019 Jun 14.

How do I audit intraoperative blood component utilization in cardiac surgery?

Nadia B Hensley  1 , Brian C Cho  1 , Mereze Visagie  1 , Laeben C Lester  1 , James H Abernathy 3rd  1 , Steven M Frank  1   2
Affiliations

How do I audit intraoperative blood component utilization in cardiac surgery?

Nadia B Hensley et al. Transfusion. 2019 Oct.

Abstract

Background: Patient blood management programs are tasked with auditing transfusions for appropriateness; however, cardiac surgical programs have high variability in blood utilization. After benchmarking intraoperative blood utilization as higher than expected, we devised effective methods for audits with feedback to the cardiac anesthesiologists that are described in this report.

Study design and methods: Red blood cell (RBC), plasma, platelet (PLT), and cryoprecipitate transfusion data were collected from the electronic record system for 2242 patients having cardiac surgery from July 2016 until July 2018. In July 2017, we performed audits with feedback using rank-order bar graphs displayed on the anesthesiology office door for intraoperative blood utilization. Individual providers were compared to their peers for all four major blood components, with the goal of improving practice by reducing variability.

Results: After the audits with feedback, the intraoperative mean units/patient decreased for RBCs (from 1.9 to 1.2 units/patient; p = 0.0004), for plasma (from 1.8 to 1.2 units/patient; p = 0.0038), and for PLTs (from 0.7 to 0.4 units/patient; p < 0.0001), but not for cryoprecipitate (from 0.24 to 0.18 units/patient; p = 0.13). Whole hospital (from admit to discharge) utilization decreased significantly for plasma and PLTs, but the changes for RBCs and cryoprecipitate were nonsignificant.

Conclusion: Despite challenges in abstracting data from the electronic medical record, using such data to create provider-specific audits with feedback can be an effective tool to promote quality improvement. Future plans include audits with feedback for providers who order transfusion outside the operating room.

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References

REFERENCES

    1. Shehata N, Mistry N, da Costa BR, et al. Restrictive compared with liberal red cell transfusion strategies in cardiac surgery: a meta-analysis. Eur Heart J 2019;40:1081-8.
    1. Goodnough LT, Shieh L, Hadhazy E, et al. Improved blood utilization using real-time clinical decision support. Transfusion 2014;54:1358-65.
    1. Shore-Lesserson L, Manspeizer HE, DePerio M, et al. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg 1999;88:312-9.
    1. Gross I, Seifert B, Hofmann A, et al. Patient blood management in cardiac surgery results in fewer transfusions and better outcome. Transfusion 2015;55:1075-81.
    1. Fleming K, Redfern RE, March RL, et al. TEG-directed transfusion in complex cardiac surgery: impact on blood product usage. J Extra Corpor Technol 2017;49:283-90.

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