Hicks Caitlin W, Liu Jing, Yang William W, DiBrito Sandra R, Johnson Daniel J, Brito Alexandra, Higgins Robert S D, Frank Steven M, Wick Elizabeth C
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Johns Hopkins Health System Blood Management Program, Baltimore, MD, USA.
Am J Surg. 2017 Oct;214(4):571-576. doi: 10.1016/j.amjsurg.2017.06.020. Epub 2017 Jun 29.
We implemented a comprehensive Choosing Wisely initiative to reduce unnecessary transfusions in an Academic Department of Surgery.
We conducted a survey- and lecture-based educational intervention to increase awareness about published transfusion guidelines. Monthly transfusion reports were subsequently distributed to all faculty, fellows, residents, and mid-level practitioners. Blood utilization measures were compared pre- vs. post-intervention to assess effectiveness.
7994 blood product orders (5388 pre-intervention, 2606 post-intervention) were placed (07/2014-06/2016). Red blood cell (RBC) (45% vs. 55%; P < 0.001) and plasma (68% vs. 75%; P = 0.02) compliance improved post-intervention, with a corresponding 15% decrease in RBC utilization (0.47 ± 0.02 vs. 0.40 ± 0.02 units/patient; P = 0.01), and 24% decrease in plasma (0.25 ± 0.02 vs. 0.19 ± 0.02 units/patient; P = 0.06). These reductions translate into $125,558 in blood product acquisition cost avoidance (RBC = $114,386, plasma = $11,172).
Implementation of a comprehensive Choosing Wisely campaign targeting individual providers at all levels significantly improved transfusion practices and decreased costs within the Department of Surgery.
我们在一个外科教研室实施了一项全面的“明智选择”倡议，以减少不必要的输血。
我们开展了一项基于调查和讲座的教育干预措施，以提高对已发布输血指南的认识。随后，每月向所有教员、研究员、住院医师和中级从业者分发输血报告。比较干预前后的血液利用指标，以评估有效性。
共下达了7994份血液制品订单（干预前5388份，干预后2606份）（2014年7月至2016年6月）。干预后，红细胞（RBC）（45%对55%；P<0.001）和血浆（68%对75%；P=0.02）的合规性有所改善，RBC利用率相应下降了15%（0.47±0.02对0.40±0.02单位/患者；P=0.01），血浆下降了24%（0.25±0.02对0.19±0.02单位/患者；P=0.06）。这些减少转化为避免了125,558美元的血液制品采购成本（RBC=114,386美元，血浆=11,172美元）。
针对各级个体医疗服务提供者实施全面的“明智选择”活动，显著改善了输血实践，并降低了外科教研室的成本。
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