Improved outcomes and reduced costs associated with a health‐system–wide patient blood management program: a retrospective observational study in four major adult tertiary‐care hospitals

Transfusion - Tập 57 Số 6 - Trang 1347-1358 - 2017
Michael F. Leahy1,2,3, Axel Hofmann4,5,6, Simon Towler7, Kevin M. Trentino8, Sally Burrows3, Stuart G. Swain8, Jeffrey M. Hamdorf9,10, Trudi Gallagher11,12, Audrey Koay12, Gary C. Geelhoed12,13, Shannon Farmer14,10
1Department of Haematology, Royal Perth Hospital
2PathWest Laboratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
3School of Medicine and Pharmacology, The University of Western Australia
4Centre for Population Health Research, Curtin University, Perth, Western Australia, Australia
5Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
6School of Surgery, University of Western Australia
7Service 4, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
8Business Intelligence Unit, South Metropolitan Health Service
9Clinical Training and Evaluation Centre (CTEC), University of Western Australia, Perth, Western Australia, Australia
10School of Surgery, Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia
11Accumen LLC, San Diego, California
12Department of Health, Western Australia, Australia
13School of Paediatrics and Child Health and School of Primary and Aboriginal and Rural Health, The University of Western Australia, Perth, Western Australia, Australia
14Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia

Tóm tắt

BACKGROUNDPatient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health‐system–wide PBM program. This study assesses program outcomes.STUDY DESIGN AND METHODSThis was a retrospective study of 605,046 patients admitted to four major adult tertiary‐care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh‐frozen plasma (FFP), and platelet units transfused; single‐unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity‐based costs of transfusion; in‐hospital mortality; length of stay; 28‐day all‐cause emergency readmissions; and hospital‐acquired complications.RESULTSComparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p < 0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity‐based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p < 0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p = 0.001). Single‐unit RBC transfusions increased from 33.3% to 63.7% (p < 0.001). There were risk‐adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67‐0.77; p < 0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84‐0.87; p < 0.001), hospital‐acquired infections (OR, 0.79; 95% CI, 0.73‐0.86; p < 0.001), and acute myocardial infarction‐stroke (OR, 0.69; 95% CI, 0.58‐0.82; p < 0.001). All‐cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02‐1.10; p = 0.001).CONCLUSIONImplementation of a unique, jurisdiction‐wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product‐related cost savings.

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Transfusion

Tập 57 Số 6

1347-1358

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