Improving Outcomes in a Complex Health Care System: Lessons From Complex Cranial Vault Reconstruction.

Abstract

Reducing blood donor exposure (BDE) is a meaningful improvement goal for many conditions and procedures that require a transfusion of blood products. Complex cranial vault reconstruction (CCVR) in children is a procedure that routinely requires a large-volume blood transfusion, with intraoperative blood loss routinely exceeding the circulating blood volume1–4 and ongoing losses often leading to postoperative transfusions. Large-volume transfusions increase the risk for coagulopathy5 and a need for additional blood products; increasing donor exposure increases the risk for infection, transfusion reactions, and alloimmunization.6 Optimizing the transfusion management for CCVR requires a high degree of care coordination because multiple providers are involved in the care of these children in the preoperative, intraoperative, and postoperative setting.1 In addition, an optimal transfusion strategy for this particular population has not been previously established. In this issue of Hospital Pediatrics , Muhly et al7 report the use of sequential interventions and the evaluation of outcomes over time to achieve an overall goal of reducing BDEs. They also achieve a secondary goal of reducing the overall blood transfusion volume in the CCVR population. Although …