Single-unit transfusions and hemoglobin trigger: Relative impact on red cell utilization

William W. Yang, Rajiv N. Thakkar, Eric Gehrie, Weiyun Chen, Steven Mark Frank

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Patient blood management (PBM) programs can reduce unnecessary transfusions, but the optimal methods used to achieve this effect are unclear. We tested the hypothesis that encouraging single-unit red blood cell (RBC) transfusions in stable patients would have a greater impact on blood use than compliance with a specific hemoglobin (Hb) transfusion trigger alone. STUDY DESIGN AND METHODS: We analyzed blood utilization data at three community hospitals without previous PBM efforts before and after implementing a PBM program. Data were analyzed at monthly intervals to determine the relative impact of a "Why give 2 when 1 will do?" campaign promoting single-unit RBC transfusions and simultaneous efforts to promote evidence-based Hb triggers of 7 or 8 g/dL. Univariate and multivariate analyses were used to identify independent effects of these two interventions on overall RBC utilization. RESULTS: Univariate analysis revealed that both the increase in single-unit transfusions (from 38.0% to 70.9%; p<0.0001) and the decrease in RBC orders with an Hb trigger of at least 8 g/dL (from 45.7% to 25.0%; p<0.0001) were associated with decreasing RBC utilization. Multivariate analysis showed that the increase in single-unit transfusions was an independent predictor of decreased RBC utilization, but the Hb triggers of both 7 and 8 g/dL were not. Overall, our PBM efforts decreased RBC utilization from 0.254 to 0.185 units/patient (27.2%) across all three hospitals (p=0.0009). CONCLUSIONS: A campaign promoting single-unit RBC transfusions had a greater impact on RBC utilization than did encouraging a restrictive transfusion trigger.

Original languageEnglish (US)
JournalTransfusion
DOIs
StateAccepted/In press - 2017

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Hemoglobins
Erythrocytes
Erythrocyte Transfusion
Multivariate Analysis
Community Hospital

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Single-unit transfusions and hemoglobin trigger : Relative impact on red cell utilization. / Yang, William W.; Thakkar, Rajiv N.; Gehrie, Eric; Chen, Weiyun; Frank, Steven Mark.

In: Transfusion, 2017.

Research output: Contribution to journalArticle

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title = "Single-unit transfusions and hemoglobin trigger: Relative impact on red cell utilization",
abstract = "BACKGROUND: Patient blood management (PBM) programs can reduce unnecessary transfusions, but the optimal methods used to achieve this effect are unclear. We tested the hypothesis that encouraging single-unit red blood cell (RBC) transfusions in stable patients would have a greater impact on blood use than compliance with a specific hemoglobin (Hb) transfusion trigger alone. STUDY DESIGN AND METHODS: We analyzed blood utilization data at three community hospitals without previous PBM efforts before and after implementing a PBM program. Data were analyzed at monthly intervals to determine the relative impact of a {"}Why give 2 when 1 will do?{"} campaign promoting single-unit RBC transfusions and simultaneous efforts to promote evidence-based Hb triggers of 7 or 8 g/dL. Univariate and multivariate analyses were used to identify independent effects of these two interventions on overall RBC utilization. RESULTS: Univariate analysis revealed that both the increase in single-unit transfusions (from 38.0{\%} to 70.9{\%}; p<0.0001) and the decrease in RBC orders with an Hb trigger of at least 8 g/dL (from 45.7{\%} to 25.0{\%}; p<0.0001) were associated with decreasing RBC utilization. Multivariate analysis showed that the increase in single-unit transfusions was an independent predictor of decreased RBC utilization, but the Hb triggers of both 7 and 8 g/dL were not. Overall, our PBM efforts decreased RBC utilization from 0.254 to 0.185 units/patient (27.2{\%}) across all three hospitals (p=0.0009). CONCLUSIONS: A campaign promoting single-unit RBC transfusions had a greater impact on RBC utilization than did encouraging a restrictive transfusion trigger.",
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T1 - Single-unit transfusions and hemoglobin trigger

T2 - Relative impact on red cell utilization

AU - Yang, William W.

AU - Thakkar, Rajiv N.

AU - Gehrie, Eric

AU - Chen, Weiyun

AU - Frank, Steven Mark

PY - 2017

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N2 - BACKGROUND: Patient blood management (PBM) programs can reduce unnecessary transfusions, but the optimal methods used to achieve this effect are unclear. We tested the hypothesis that encouraging single-unit red blood cell (RBC) transfusions in stable patients would have a greater impact on blood use than compliance with a specific hemoglobin (Hb) transfusion trigger alone. STUDY DESIGN AND METHODS: We analyzed blood utilization data at three community hospitals without previous PBM efforts before and after implementing a PBM program. Data were analyzed at monthly intervals to determine the relative impact of a "Why give 2 when 1 will do?" campaign promoting single-unit RBC transfusions and simultaneous efforts to promote evidence-based Hb triggers of 7 or 8 g/dL. Univariate and multivariate analyses were used to identify independent effects of these two interventions on overall RBC utilization. RESULTS: Univariate analysis revealed that both the increase in single-unit transfusions (from 38.0% to 70.9%; p<0.0001) and the decrease in RBC orders with an Hb trigger of at least 8 g/dL (from 45.7% to 25.0%; p<0.0001) were associated with decreasing RBC utilization. Multivariate analysis showed that the increase in single-unit transfusions was an independent predictor of decreased RBC utilization, but the Hb triggers of both 7 and 8 g/dL were not. Overall, our PBM efforts decreased RBC utilization from 0.254 to 0.185 units/patient (27.2%) across all three hospitals (p=0.0009). CONCLUSIONS: A campaign promoting single-unit RBC transfusions had a greater impact on RBC utilization than did encouraging a restrictive transfusion trigger.

AB - BACKGROUND: Patient blood management (PBM) programs can reduce unnecessary transfusions, but the optimal methods used to achieve this effect are unclear. We tested the hypothesis that encouraging single-unit red blood cell (RBC) transfusions in stable patients would have a greater impact on blood use than compliance with a specific hemoglobin (Hb) transfusion trigger alone. STUDY DESIGN AND METHODS: We analyzed blood utilization data at three community hospitals without previous PBM efforts before and after implementing a PBM program. Data were analyzed at monthly intervals to determine the relative impact of a "Why give 2 when 1 will do?" campaign promoting single-unit RBC transfusions and simultaneous efforts to promote evidence-based Hb triggers of 7 or 8 g/dL. Univariate and multivariate analyses were used to identify independent effects of these two interventions on overall RBC utilization. RESULTS: Univariate analysis revealed that both the increase in single-unit transfusions (from 38.0% to 70.9%; p<0.0001) and the decrease in RBC orders with an Hb trigger of at least 8 g/dL (from 45.7% to 25.0%; p<0.0001) were associated with decreasing RBC utilization. Multivariate analysis showed that the increase in single-unit transfusions was an independent predictor of decreased RBC utilization, but the Hb triggers of both 7 and 8 g/dL were not. Overall, our PBM efforts decreased RBC utilization from 0.254 to 0.185 units/patient (27.2%) across all three hospitals (p=0.0009). CONCLUSIONS: A campaign promoting single-unit RBC transfusions had a greater impact on RBC utilization than did encouraging a restrictive transfusion trigger.

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