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A prospective analysis of Aurora St. Luke's Medical Center transfusion practices and a proposal for quality improvement of blood product administration : a thesis submitted to the faculty of the Milwaukee School of Engineering in partial fulfillment of the requirements for the degree of Master of Science in Perfusion / by Samantha Varso.

by Varso, Samantha, author., Gerrits, Dr. Ronald, thesis advisor , Hietpas, Matthew, committee member , Shimek, Gary , Milwaukee School of Engineering

[Milwaukee School of Engineering], [2016]

Blood loss, Surgical.

Blood -- Transfusion

Medical care -- Quality control

Auditing, Internal

Total quality management

43 leaves : illustrations ; 29 cm

Introduction -- Background -- Methods -- Results -- Discussion -- Conclusion -- Appendix A: STS procedure classifications -- B: Plan-Do-Study-Act (PDSA) document -- C: Transfusion data tool.

Although red blood cell transfusions are common treatment for postoperative anemia in cardiac surgery patients, homologous blood products can initiate various morbidities or mortality. The decision to transfuse must be based on supported clinical evidence, and clinical sites are expected to maintain a transfusion-tracking database to provide this clinical evidence for future decision making. But it is often a challenge to maintain such a database in a manner that provides reliable data. This was exemplified when the Aurora St. Luke's Medical Center (ASLMC) cardiothoracic surgery department was flagged with inappropriate blood usage for January through July 2015 by the reporting company Accumen. The department believed that the report may have not been reflective of the actual transfusion practices in the department. In order to better understand the blood product usages of the ASLMC cardiothoracic (CT) surgery department, a Plan-Do-Study-Act (PDSA) concept was applied to the blood usage practices of Society of Thoracic Surgery (STS) procedure patients in the cardiovascular intensive care unit (CVICU). The goals of the PDSA cycle were to accurately characterize how transfusions are given by collecting data that characterize and provide a more thorough context of the transfusion process.

A prospective analysis was performed on data from cardiac surgical patients in the ASLMC CVICU between January 1, 2016 and January 31, 2016. All data were obtained manually from the ASLMC electronic database EPIC. The electronic charts for 72 STS procedure patients were analyzed for packed red blood cell (PRBC) transfusion records, resulting in data for 51 transfusions for 27 patients. Data collected included transfusion indications, ordering hemoglobin (hgb) concentrations, and other hemodynamic variables. The percentage of transfusions ordered as single units, ordered with a hgb <7 g/dL, and ordered with a hgb >8 g/dL were calculated and compared to the minimum goal value as well as the transfusion data for all departments and CT surgery from July through December 2015. Additionally, admit hgb was also reviewed to determine the average degree of anemia of patients upon admittance to the CVICU.

The results of the PDSA cycle showed that 46% of transfusions were given when hgb <7 gm/dL, 19% of transfusions were given when hgb >8 gm/dL, and 92% of PRBC transfusions were ordered as single units, compared to the goal minimums of at least 50%, less than 15%, and at least 50% respectively. Analysis of other recorded hemodynamic corresponding to the time of recorded transfusions shows an inconsistency of data recording, causing difficulty for accurate transfusion characterization. This project demonstrated that for STS procedure patients housed in the CVICU in January 2016, the hgb trigger-based goals were not reached, but the single unit per order goal was achieved. The removal of non-STS procedure patients improved the transfusion outcomes for the CVICU, indicating that the patient blood management of non-STS patients should be handled with different blood management algorithms.

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