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University of Michigan Hospitalist Program

Improving the Appropriateness of Packed Red Blood Cell Transfusions for Patients Admitted on the General Medicine Services

A description of the main goals of the initiative:

This project aims to improve the overall appropriateness of RBC transfusions given to patients admitted to the general medicine services.  This will be accomplished by improving physicians’ understanding and awareness of institutional guidelines that are in place to help direct RBC transfusion practices, as well as allowing physicians to review their own transfusion practices and compare them to their peers’ in addition to monitoring the appropriateness of their RBC transfusions based on lab parameters.

A brief discussion of the scope of the project, and the interventions and metrics, if appropriate:
Metrics:

1. Percentage of an individual physician’s orders for red blood cell transfusions that meet pre-transfusion lab criteria for hemoglobin and hematocrit.
2. Percentage of total orders for red blood cell transfusions that meet pre-transfusion lab criteria for hemoglobin and hematocrit
3. Percentage of physicians with > 90% of their orders for RBC transfusions for patients with a pre-transfusion hemoglobin < 8.3 g/dL or hematocrit < 25%

Interventions:

An educational campaign presented to the group drawing attention to data indicating improved outcomes with a restrictive transfusion protocol as well as drawing attention to the institutional guidelines.  Specific feedback presented to each individual physician on a quarterly basis in the form of an email containing the data.  Each physician could then assess how they are performing as compared to their peers as well as enabling them to go back and review specific cases that were felt to be outliers based on laboratory parameters.

Participants: Jeff Rohde

 

 
   
   

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