Reduced blood product utilization via implementation of an anemia clinic and consult service in a large health system hospital.

Abstract

e14142 Background: An Anemia Clinic program was started Sept. 2016 as part of system wide implementation of Patient Blood Management (PBM) initiated in 2015. Methods: The Anemia Clinic accepted referrals for non-cancer anemia, predominantly preoperative cardiovascular surgery (CVS) Pts. Hgb thresholds were < 13 g/dL in men and < 12 g/dL in women. Non-anemia cytopenias triggered Hematology referral. All Pts were screened for iron, B12, folate, and reticulocyte. Nutrient deficiencies were supplemented. Pts with CKD or chronic disease were considered for erythropoiesis stimulating agents. Results: PBM implementation resulted in a drop in packed red blood cell (PRBC) usage (Table). Of CVS Pts pre-operatively anemic in 2019, 180 were referred to the Anemia Clinic and 301 were not. Anemia Clinic identified iron (N = 114), vitamin B12 (N = 24), and folate (N = 18) deficiencies. The percentage of Pts who received PRBCs after Anemia Clinic referral was not statistically different from those who were not referred (65.6% vs. 61.8% Chi-Square p = 0.44). Of preoperatively anemic Pts who were transfused in 2019, an average of 2.34 PRBCs were used in the referred group vs. an average of 2.21 PRBCs in those in the not referred group (Poisson Means p = 0.46). Length of stay (LOS) which was a median 10d ( P25= 7d, P75 =17d) in the referred group vs a median 12d ( P25= 7d, P75 =19d) in the non-referred group was not statistically different between groups (Smirnov p = 0.39). LOS analyses of observed-to-expected (O/E) ratios used the Premier Healthcare Providers Alliance Database (PHD) which contains data on approximately 45% of US hospital discharges. For 2019 through Nov. the referred group had an O/E = 1.03 (observed LOS μgeo = 11.58 days, expected LOS μgeo = 11.21 days, N = 167). The not referred group had an O/E = 1.06 (observed LOS μgeo = 12.24 days, expected LOS μgeo = 11.58 days, N = 272). Conclusions: PBM decreased PRBC use through systematization of best practices during the initial year. Subsequent addition of Anemia Clinic services has not decreased PRBC use further. There is a trend toward shorter LOS for patients referred to Anemia Clinic but it is not statistically significant. Our methods improved nutrient deficiency identification which may improve both later health outcomes not detected here and access to treatment for hematologic malignancies. [Table: see text]