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

被引：316

作者：

Leahy, Michael F. ^{[1
,2
,3
]}

Hofmann, Axel ^{[4
,5
,6
]}

Towler, Simon ^{[7
]}

Trentino, Kevin M. ^{[8
]}

Burrows, Sally A. ^{[1
]}

Swain, Stuart G. ^{[8
]}

Hamdorf, Jeffrey ^{[9
,10
]}

Gallagher, Trudi ^{[11
,12
]}

Koay, Audrey ^{[11
]}

Geelhoed, Gary C. ^{[11
,13
,14
]}

Farmer, Shannon L. ^{[9
,15
]}

机构：

[1] Univ Western Australia, Sch Med & Pharmacol, Perth, WA, Australia

[2] Royal Perth Hosp, Dept Haematol, Perth, WA 6000, Australia

[3] Royal Perth Hosp, PathWest Lab Med, Perth, WA, Australia

[4] Univ Hosp Zurich, Dept Anesthesiol, Zurich, Switzerland

[5] Univ Western Australia, Sch Surg, Perth, WA, Australia

[6] Curtin Univ, Ctr Populat Hlth Res, Perth, WA, Australia

[7] Fiona Stanley Hosp, Serv 4, Murdoch, WA, Australia

[8] Univ Western Australia, South Metropolitan Hlth Serv, Business Intelligence Unit, Perth, WA, Australia

[9] Univ Western Australia, Fac Med Dent & Hlth Sci, Sch Surg, Perth, WA, Australia

[10] Univ Western Australia, CTEC, Perth, WA, Australia

[11] Dept Hlth, Perth, WA, Australia

[12] Accumen LLC, San Diego, CA USA

[13] Univ Western Australia, Sch Paediat & Child Hlth, Perth, WA, Australia

[14] Univ Western Australia, Sch Primary & Aboriginal & Rural Hlth, Perth, WA, Australia

[15] Curtin Univ, Ctr Populat Hlth Res, Fac Hlth Sci, Perth, WA, Australia

来源：

TRANSFUSION | 2017年 / 57卷 / 06期

关键词：

CELL TRANSFUSION; CARDIAC-SURGERY; PLASMA TRANSFUSIONS; FEWER TRANSFUSIONS; CLINICAL-OUTCOMES; WESTERN-AUSTRALIA; MORTALITY; STRATEGIES; CONSERVATION; METAANALYSIS;

D O I：

10.1111/trf.14006

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1347 / 1358

页数：12

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