Background/Case Studies: Multiple efforts have been implemented in a 12-hospital healthcare system. The purpose was to increase the rate of transfusion of single unit red blood cell (RBC) among patients with appropriate indications (Hb < 7g/dL or Hb < 8 g/dL with cardiovascular disease), as well as to decrease the inappropriate under-dosing of plasma (single unit of plasma) as its volume must be dosed in a weight-based fashion (10-20 ml/kg).
Study
Design/Methods: We analyzed the change in performance in RBC transfusion from 2012 to 2022 since the implementation of several strategies in the electronic health record that included default ordering to one unit; clinical decision support embedded within the order set; and multiple education initiatives and leadership engagement. We analyzed the data on single-unit plasma transfusion for the period of 2019 to 2022. Main strategies to decrease plasma underdosing involved education of providers, data sharing to both individual providers and leadership.
Results/Findings: For RBC transfusion we were able to see a decrease in transfusion of multiple units and an increase in single unit at each transfusion episode; from a baseline of 61% for multiple units in 2012, it had a steady decrease to 35% in 2022. For plasma, the transfusion of single units decreased from a baseline of 20.7% in 2019 to 14.6% in 2022 . Conclusions:
Conclusion: The longitudinal strategies implemented in a healthcare system have demonstrated sustained efficacy in increasing high-value care in the transfusion of RBC and plasma. In a 10-year period, transfusion of multiple RBC units has decreased by almost 57% Transfusion of single-unit plasma has decreased by 30% in a 4-year period.
Importance of research: This emphasizes the importance of iterative processes for leadership and frontline stakeholders involvement in more judicious blood utilization. It adds data on the emphasis in decreasing underdosing of plasma, as well as avoiding unnecessary plasma transfusion.
