Implementation of a Comprehensive Patient Blood Management Program for Hospitalized Patients at a Large United States Medical Center |
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| Affiliation: | 1. Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN;2. Patient Blood Management Program, Mayo Clinic, Rochester, MN;3. Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN;4. Anesthesia Clinical Research Unit, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN;5. Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN;1. Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL;2. Advisor to residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL;1. Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL;2. Quantitative Sciences Unit, School of Medicine, Stanford, CA;3. Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA;4. Division of Preventive Medicine, Brigham and Women''s Hospital, Harvard Medical School, Boston, MA;5. School of Nursing, University of Washington, Seattle, WA;6. Department of Epidemiology, School of Public Health, Brown University, Providence, RI;7. Center for Primary Care and Prevention, Kent Hospital, Pawtucket, RI;8. Department of Family Medicine, Brown University Alpert Medical School, Providence, RI;9. Division of Cardiology, School of Medicine and Health Sciences, George Washington University, Washington, DC;10. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY;11. Division of Cardiovascular Medicine, School of Medicine, Stanford University, Stanford, CA;12. Palo Alto VA Healthcare System, Palo Alto, CA;1. Department of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY;2. Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, LA;3. Department of Imaging and Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA |
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| Abstract: | ObjectiveTo assess changes in inpatient transfusion utilization and patient outcomes with implementation of a comprehensive patient blood management (PBM) program at a large US medical center.Patients and MethodsThis is an observational study of graduated PBM implementation for hospitalized adults (age ≥18 years) from January 1, 2010, through December 31, 2017, at two integrated hospital campuses at a major academic US medical center. Allogeneic transfusion utilization and clinical outcomes were assessed over time through segmented regression with multivariable adjustment comparing observed outcomes against projected outcomes in the absence of PBM activities.ResultsIn total, 400,998 admissions were included. Total allogeneic transfusions per 1000 admissions decreased from 607 to 405 over the study time frame, corresponding to an absolute risk reduction for transfusion of 6.0% (95% confidence interval [CI]: 3.6%, 8.3%; P<.001) and a 22% (95% CI: 6%, 37%; P=.006) decrease in the rate of transfusions over projected. The risk of transfusion decreased for all blood components except cryoprecipitate. Transfusion reductions were experienced for all major surgery types except liver transplantation, which remained stable over time. Hospital length of stay (multiplicative increase in geometric mean 0.85 [95% CI: 0.81, 0.89]; P<.001) and incident in-hospital adverse events (absolute risk reduction: 1.5% [95% CI: 0.1%, 3.0%]; P=.04) were lower than projected at the end of the study time frame.ConclusionPatient blood management implementation for hospitalized patients in a large academic center was associated with substantial reductions in transfusion utilization and improved clinical outcomes. Broad-scale implementation of PBM in US hospitals is feasible without signal for patient harm. |
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