Trivedi Mira, Sheth Shreya, Cooper Felicia, Elhoff Justin, Rodrigues Miranda A, Stapleton Gary
Department of Pediatrics, Section of Cardiology, Indiana University, Indianapolis, IN, USA.
Pediatric Cardiology, Riley Hospital for Children, Indianapolis, IN, USA.
Pediatr Cardiol. 2024 Oct 21. doi: 10.1007/s00246-024-03682-8.
Packed red blood cells (PRBC) are frequently ordered for cardiac catheterization procedures, which increases resource utilization and patient charges. We applied the Plan-Do-Study-Act (PDSA) principle in order to optimize the ordering of PRBC for pediatric cardiac procedures and reducing charges. Our primary aim was to increase adherence to ordering guidelines to greater than 97%, with a global aim to reduce resource utilization. The existing PRBC ordering guidelines were revised and procedure reports were updated to include administration of PRBC. The rate of pre-procedure PRBC orders, adherence to the new protocol guidelines, presence of documentation and rate of blood transfusion within 24 h post-procedure, frequency of emergency release blood during a procedure were monitored. During our study period, there was an increased adherence from 86 to 100% adherence following implementation of the updated guidelines. With improved adherence, we decreased PRBC ordering and hospital charges to the patient in low-risk cardiac catheterization procedures, without an increase in blood transfusions.
对于心脏导管插入术，经常会开出浓缩红细胞（PRBC）的医嘱，这增加了资源利用和患者费用。我们应用了计划-实施-研究-改进（PDSA）原则，以优化儿科心脏手术中PRBC的医嘱并降低费用。我们的主要目标是将医嘱遵循指南的比例提高到97%以上，总体目标是减少资源利用。修订了现有的PRBC医嘱指南，并更新了手术报告以包括PRBC的使用情况。监测术前PRBC医嘱的比例、对新方案指南的遵循情况、记录的存在情况以及术后24小时内的输血比例、手术期间紧急发放血液的频率。在我们的研究期间，实施更新后的指南后，遵循率从86%提高到了100%。随着遵循情况的改善，我们在低风险心脏导管插入术中减少了PRBC的医嘱和患者的医院费用，且输血没有增加。
