Implementing a program to improve compliance with neonatal intensive care unit transfusion guidelines was accompanied by a reduction in transfusion rate: a pre-post analysis within a multihospital health care system

Authors

  • Vickie L. Baer,

    1. From the Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah; the McKay-Dee Hospital Center, Ogden, Utah; the Institute for Healthcare Delivery Research, Salt Lake City, Utah; Utah Valley Regional Medical Center, Provo, Utah; the Intermountain Medical Center, Murray, Utah; the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; and the Dixie Regional Medical Center, St George, Utah.
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  • Erick Henry,

    1. From the Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah; the McKay-Dee Hospital Center, Ogden, Utah; the Institute for Healthcare Delivery Research, Salt Lake City, Utah; Utah Valley Regional Medical Center, Provo, Utah; the Intermountain Medical Center, Murray, Utah; the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; and the Dixie Regional Medical Center, St George, Utah.
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  • Diane K. Lambert,

    1. From the Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah; the McKay-Dee Hospital Center, Ogden, Utah; the Institute for Healthcare Delivery Research, Salt Lake City, Utah; Utah Valley Regional Medical Center, Provo, Utah; the Intermountain Medical Center, Murray, Utah; the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; and the Dixie Regional Medical Center, St George, Utah.
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  • Ronald A. Stoddard,

    1. From the Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah; the McKay-Dee Hospital Center, Ogden, Utah; the Institute for Healthcare Delivery Research, Salt Lake City, Utah; Utah Valley Regional Medical Center, Provo, Utah; the Intermountain Medical Center, Murray, Utah; the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; and the Dixie Regional Medical Center, St George, Utah.
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  • Susan E. Wiedmeier,

    1. From the Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah; the McKay-Dee Hospital Center, Ogden, Utah; the Institute for Healthcare Delivery Research, Salt Lake City, Utah; Utah Valley Regional Medical Center, Provo, Utah; the Intermountain Medical Center, Murray, Utah; the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; and the Dixie Regional Medical Center, St George, Utah.
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  • Larry D. Eggert,

    1. From the Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah; the McKay-Dee Hospital Center, Ogden, Utah; the Institute for Healthcare Delivery Research, Salt Lake City, Utah; Utah Valley Regional Medical Center, Provo, Utah; the Intermountain Medical Center, Murray, Utah; the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; and the Dixie Regional Medical Center, St George, Utah.
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  • Sarah Ilstrup,

    1. From the Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah; the McKay-Dee Hospital Center, Ogden, Utah; the Institute for Healthcare Delivery Research, Salt Lake City, Utah; Utah Valley Regional Medical Center, Provo, Utah; the Intermountain Medical Center, Murray, Utah; the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; and the Dixie Regional Medical Center, St George, Utah.
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  • Robert D. Christensen

    1. From the Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, Utah; the McKay-Dee Hospital Center, Ogden, Utah; the Institute for Healthcare Delivery Research, Salt Lake City, Utah; Utah Valley Regional Medical Center, Provo, Utah; the Intermountain Medical Center, Murray, Utah; the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; and the Dixie Regional Medical Center, St George, Utah.
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Robert D. Christensen, MD, Intermountain Healthcare, 4300 Harrison Boulevard, Ogden, UT 84403; e-mail: rdchris4@ihc.com.

Abstract

BACKGROUND: We previously reported that in the year 2006, approximately 35% of the transfusions administered in the Intermountain Healthcare neonatal intensive care units (NICU) were noncompliant with our transfusion guidelines. In January 2009 we instituted an electronic NICU transfusion ordering and monitoring system as part of a new program to improve compliance with transfusion guidelines.

STUDY DESIGN AND METHODS: In the four largest NICUs of Intermountain Healthcare, we performed a pre-post analysis of compliance with transfusion guidelines and transfusion usage.

RESULTS: After beginning the new transfusion compliance program all four NICUs had an increase in compliance from 65% to 90%. Accompanying the improved compliance, all four NICUs had a reduction in transfusions administered. Specifically, compared with 2007 and 2008, there were 984 fewer NICU transfusions given in 2009. This included 554 fewer red blood cell (RBC) transfusions, 174 fewer platelet transfusions, and 256 fewer frozen plasma infusions. We calculate that in 2009, a total of 200 NICU patients who in previous years would have received one or more transfusions instead received none. Applying specific Intermountain Healthcare billing data to the observed transfusion reductions, this new program resulted in an annual decrease of $780,074 in blood bank charges (blood administration charges were not included). During the 3-year period, January 2007 through December 2009, we detected no change in NICU demographics, major morbidities, length of hospital stay, or mortality rate.

CONCLUSION: Implementing a systemwide NICU program to improve compliance with already-established transfusion guidelines increased compliance from 65% to 90%. Improved compliance with transfusion guidelines was accompanied by a significant reduction in transfusions given, with no increase in NICU length of stay or mortality rate.

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