A comprehensive Choosing Wisely quality improvement initiative reduces unnecessary transfusions in an Academic Department of Surgery

Caitlin W Hicks; Jing Liu; William W Yang; Sandra R DiBrito; Daniel J Johnson; Alexandra Brito; Robert S D Higgins; Steven M Frank; Elizabeth C Wick

doi:10.1016/j.amjsurg.2017.06.020

A comprehensive Choosing Wisely quality improvement initiative reduces unnecessary transfusions in an Academic Department of Surgery

Am J Surg. 2017 Oct;214(4):571-576. doi: 10.1016/j.amjsurg.2017.06.020. Epub 2017 Jun 29.

Authors

Caitlin W Hicks¹, Jing Liu², William W Yang², Sandra R DiBrito³, Daniel J Johnson², Alexandra Brito⁴, Robert S D Higgins³, Steven M Frank⁵, Elizabeth C Wick⁶

Affiliations

¹ Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: chicks11@jhmi.edu.
² Johns Hopkins Health System Blood Management Program, Baltimore, MD, USA.
³ Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
⁴ Department of Surgery, University of California San Diego, San Diego, CA, USA.
⁵ Johns Hopkins Health System Blood Management Program, Baltimore, MD, USA; Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
⁶ Department of Surgery, University of California San Francisco, San Francisco, CA, USA.

PMID: 28683893
DOI: 10.1016/j.amjsurg.2017.06.020

Abstract

Background: We implemented a comprehensive Choosing Wisely initiative to reduce unnecessary transfusions in an Academic Department of Surgery.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Choosing Wisely; Quality improvement; Resident initiative; Transfusion medicine.

MeSH terms

Academic Medical Centers
Attitude of Health Personnel
Blood Transfusion / standards*
Choice Behavior*
Humans
Inservice Training
Practice Guidelines as Topic
Quality Improvement*
Surgery Department, Hospital / standards*
Unnecessary Procedures / statistics & numerical data*