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Determination of Unnecessary Blood Transfusion by Comprehensive 15-Hospital Record Review

Authors :
David F. Jadwin
Patricia G. Fenderson
Mark T. Friedman
Ian Jenkins
Aryeh Shander
Jonathan H. Waters
Arnold Friedman
Eric Tesoriero
Majed A. Refaai
Andrew W. Shih
Tauhid Awan
Andy L. Ngo
Jaime A. Perez
James D. Reynolds
Source :
Joint Commission journal on quality and patient safety.
Publication Year :
2022

Abstract

Although unnecessary blood component transfusions are costly and pose substantial patient risks, the extent of unnecessary blood use in a community hospital setting has not been systematically measured.A 15-hospital observational analysis was performed using comprehensive retrospective review. Approximately 100 encounters (x¯ = 103.9, standard deviation [SD] ± 7.6) per hospital (6,696 total component transfusion events) were reviewed between 2012 and 2018. Review was performed by two medical directors. Findings were supported by blind intra- and inter-reviewer double review and blind external review by 10 independent reviewers.Patients received an average of 4.3 (± 1.3) units. Only 8.2% (± 6.7) of patient encounters did not receive unnecessary units. Fifty-five percent (54.6% ± 13.5) could have been managed without at least one component type, while 44.6% (± 14.9) could have been managed completely without transfusion. Forty-five percent (45.4% ± 17.0) of red blood cell, 54.9% (± 19.3) of plasma-cryoprecipitate, and 38.0% (± 15.6) of plateletpheresis encounters could likely have been managed without transfusion. Between 2,713 units (40.5%) and 3,306 units (49.4%) were likely unnecessary. In patients who could have been managed without transfusion of at least one component type, unnecessary blood use was associated with a 0.38 (± 0.11)-day increase in length of hospital stay for each additional unnecessary unit received (p0.001).Substantial unnecessary blood use was identified, all of which was unrecognized by hospitals prior to review. Unnecessary blood use was attributed to overreliance on laboratory transfusion criteria and failure to follow common blood management principles, which resulted in potential harm to patients and avoidable cost.

Subjects

Subjects :
Leadership and Management

Details

ISSN :
1938131X
Database :
OpenAIRE
Journal :
Joint Commission journal on quality and patient safety
Accession number :
edsair.doi.dedup.....ae25d95bfa4c10a21c75acaf832a2bec