Abstract

Purpose: To reduce RBC transfusion within a multicentre project of the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) through implementation of industry guidelines and avoidance of anaemia. Methodology: This multicentre project was modelled on a single centre 3 phase study, where current processes were identified (phase I) then new protocols implemented (phase II) and follow-up monitoring of progress was undertaken (phase III) [[1]Likosky D.S. Surgenor S.D. Dacey L.J. et al.Rationalizing the treatment of anaemia in cardiac surgery: short and mid-term results from a local quality improvement initiative.Qual Saf Health Care. 2010; 19: 392-398Crossref PubMed Scopus (12) Google Scholar]. Local sites formed a local multi-disciplinary quality improvement team to review current practice and incidence of transfusion for their site (phase 1). Our team included cardiac surgery, anaesthetics, CICU, haematology, blood bank and perfusion. This team would then review current literature and guidelines and select initiatives and changes in practice they considered worthwhile (phase II). These were then relayed to staff and introduced. Then a 3- and 6-month follow-up reporting changes in incidence of RBC transfusion fed back to team members and their staff was undertaken (phase III). Concurrently, indications for each transfusion were also recorded in line with the project model. Results: At our centre, each discipline was involved in introducing a variety of simple wide-reaching evidence-based strategies with very small costs with spectacular results. Our centre has had a 57% reduction in the number of RBC units transfused for our open heart, RBC transfusion rate per 6 months has fallen 20%, and of those transfused, patients receiving more than 2 units has dropped 13%. Also, a 34% reduction in units of platelets given, 50% reduction in cryoprecipitate units and 49% reduction in units of FFP transfused. These changes in practice continue to improve transfusion rates. Conclusion: A multidisciplinary team approach to RBC conservation using well established evidence-based guidelines can effectively optimise the use of blood products in a cardiac surgical setting and in a cost effective manner.

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