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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)571-576
Number of pages6
JournalAmerican journal of surgery
Volume214
Issue number4
DOIs
StatePublished - Oct 2017

Keywords

  • Choosing Wisely
  • Quality improvement
  • Resident initiative
  • Transfusion medicine

ASJC Scopus subject areas

  • Surgery

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