Abstract 176: Optimizing Blood Product Utilization In The Cardiac Catheterization Laboratory

Background: Packed red blood cells (PRBC) are often ordered for pediatric cardiac catheterizations (PCC) with no current appropriate use guidelines, resulting in increased utilization. A quality improvement (QI) project was created to focus on optimizing ordering of PRBC for PCC. The primary aim was to increase adherence to new guidelines to > 97%, with a global aim to decrease patient cost.

Methods: Retrospective chart review was performed to collect baseline data. For PDSA cycle 1, we updated our own PRBC ordering guidelines by risk stratifying procedures. The PCC report was updated to include documentation of PRBC ordering or transfusion. PDSA cycle 2 included further refinement of the guidelines, and improved awareness amongst those placing the pre-PCC orders. Process measures included ensuring the need for PRBC stated during every pre-PCC time-out, and consistent documentation in the PCC report. Balancing measures included monitoring the rate of PRBC transfusion within 24 hours post-PCC, and incidence of emergency release of PRBCs.

Results: For 3 months of baseline data, 112/403 of CCPs (27.8%) had PRBC ordered, 87.5% (98/112) of which followed the prior protocol, with 13/403 (3.2%) receiving PRBC transfusion during CCP. With our revised guidelines, there could be > 20% reduction in PRBC ordering, with estimated > $20,000 cost savings based on 1 crossmatch ($173) and 1 unit PRBC ($730) prepared. For PDSA cycle 1, 27/81 (33%) of PCC had PRBC ordered, with 92% adherence to the updated guidelines, and 100% documentation compliance. For PDSA cycle 2, 13/47 (27.6%) had PRBC ordered with 100% adherence to ordering guidelines. During both cycles, 3 patients had PRBC transfusions within 24 hours of their procedure for other medical reasons not related to bleeding. No cases required emergency release of PRBC. There was a statistically significant process change from a median of 86% to 100% adherence (p=0.01) since implementation of the updated guidelines.

Conclusion: With revised guidelines and improved adherence, hospital resources and charges were decreased in low-risk cardiac catheterization procedures without an increase in adverse events. This model can be utilized in other systems to similarly reduce resource utilization and costs.