TY - JOUR
T1 - Disclosure of physician-specific behavior improves blood utilization protocol adherence in cardiac surgery
AU - Beaty, Claude A.
AU - Haggerty, Kara A.
AU - Moser, Madeline G.
AU - George, Timothy J.
AU - Robinson, Chase W.
AU - Arnaoutakis, George J.
AU - Whitman, Glenn J.
N1 - Funding Information:
Drs Beaty and Arnaoutakis are the Irene Piccinini Investigators in Cardiac Surgery and Dr George is the Hugh R. Sharp Cardiac Surgery Research Fellow. This research was supported in part by a National Institutes of Health Grant: T32CA126607 . The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.
PY - 2013/12
Y1 - 2013/12
N2 - Background Evidence indicates that a transfusion (Tx) trigger hemoglobin (Hgb) value of 8 gm/dL may be safer than a more liberal Tx trigger in cardiac surgery (CS) patients. We hypothesized that weekly physician feedback would improve adherence to such a protocol, but that the public identification of individual physician behavior would have an additive effect. Methods We concurrently reviewed all adult CS patients at our institution from December 1, 2010 to May 27, 2011. We matched any cardiac surgery intensive care unit Tx event (red blood cells) with the Hgb value immediately before Tx. Patients requiring massive transfusions (>10 units/24 hours) were excluded. After all providers agreed upon a Hgb of 8 as the Tx trigger, we studied 3 consecutive time periods: no feedback, weekly feedback of group Tx behavior, and weekly feedback with identification of individual surgeon Tx behavior. Results Of the 512 patients who underwent cardiac operations, 144 patients underwent 510 Tx events. Compared with period 1, the unadjusted odds of receiving a Tx above 8 gm/dL decreased by 48% in study period 2(odds ratio: 0.52, p < 0.01), and 63% in study period 3(odds ratio: 0.37, p <0.001). Single unit transfusion rates increased from 77% to greater than 90% (p < 0.001). In-hospital mortality also fell from period 1 to period 3 (7.0% to 1.5%, p = 0.02) with the observed to expected mortality ratio decreasing from 2.19 to 0.51. Conclusions Blood transfusion protocol adherence improves when weekly feedback is provided. Identifying individual surgeon behavior improves adherence to a greater degree. Routine presentation of quality metrics with identification of individual physician-specific behavior may be the most effective way to accomplish performance improvement.
AB - Background Evidence indicates that a transfusion (Tx) trigger hemoglobin (Hgb) value of 8 gm/dL may be safer than a more liberal Tx trigger in cardiac surgery (CS) patients. We hypothesized that weekly physician feedback would improve adherence to such a protocol, but that the public identification of individual physician behavior would have an additive effect. Methods We concurrently reviewed all adult CS patients at our institution from December 1, 2010 to May 27, 2011. We matched any cardiac surgery intensive care unit Tx event (red blood cells) with the Hgb value immediately before Tx. Patients requiring massive transfusions (>10 units/24 hours) were excluded. After all providers agreed upon a Hgb of 8 as the Tx trigger, we studied 3 consecutive time periods: no feedback, weekly feedback of group Tx behavior, and weekly feedback with identification of individual surgeon Tx behavior. Results Of the 512 patients who underwent cardiac operations, 144 patients underwent 510 Tx events. Compared with period 1, the unadjusted odds of receiving a Tx above 8 gm/dL decreased by 48% in study period 2(odds ratio: 0.52, p < 0.01), and 63% in study period 3(odds ratio: 0.37, p <0.001). Single unit transfusion rates increased from 77% to greater than 90% (p < 0.001). In-hospital mortality also fell from period 1 to period 3 (7.0% to 1.5%, p = 0.02) with the observed to expected mortality ratio decreasing from 2.19 to 0.51. Conclusions Blood transfusion protocol adherence improves when weekly feedback is provided. Identifying individual surgeon behavior improves adherence to a greater degree. Routine presentation of quality metrics with identification of individual physician-specific behavior may be the most effective way to accomplish performance improvement.
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U2 - 10.1016/j.athoracsur.2013.06.080
DO - 10.1016/j.athoracsur.2013.06.080
M3 - Article
C2 - 24035308
AN - SCOPUS:84889244065
SN - 0003-4975
VL - 96
SP - 2168
EP - 2174
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -