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Role of Quality Improvement in Prevention of Inappropriate Transfusions

Mohandas, Anita MSc; Foley, Kathleen A. PhD; Nash, David B. MD, MBA; Doria, Cataldo MD, PhD, FACS

doi: 10.1097/QMH.0b013e3182315d22
Original Articles

Purpose: Many different methods are used to manage surgical bleeding and reduce transfusion. Techniques vary by institution, resulting in inconsistent outcomes. We reviewed the current literature on the quality and costs of transfusions, focusing on prevention and management of transfusions during surgery, and provide recommendations on future directions for quality improvement (QI).

Data sources: Ovid, PubMed, and Scopus.

Study selection: Key words included QI, blood loss, transfusion, hemostasis, and costs. Inclusion criteria were English language, publication between 1999 and 2010, and primary end points of blood loss, transfusion, or hemostasis.

Data extraction: A total of 1331 abstracts were reviewed; 43 met the inclusion criteria.

Results: A variety of bleeding management (BM) techniques were identified, with multiple studies suggesting that algorithms combining pre-, peri-, and postoperative interventions have the greatest potential to minimize transfusions. Most studies assessing the economic impact of BM interventions excluded resources beyond blood acquisition cost and longer-term complications, which may underestimate transfusion costs and bias estimates of the cost-effectiveness of interventions. Despite consensus on avoiding inappropriate transfusions, little agreement exists on optimal use of interventions.

Conclusions: Multifaceted algorithms show promising results. Future QI should focus on reducing practice variation via evidence-based guidelines for effective use of BM interventions.

Jefferson School of Population Health (Ms Mohandas and Dr Nash) and Division of Transplant Surgery, Department of Surgery (Dr Doria), Thomas Jefferson University, Philadelphia, Pennsylvania; and Strategic Consulting, Thomson Reuters, Cambridge, Massachusetts (Dr Foley).

The authors thank Dr Marcia Rupnow and Dr Sam (Xin) Ye for their valuable feedback on this manuscript.

The authors declare no conflict of interest.

Correspondence: Anita Mohandas, MSc, Jefferson School of Population Health, Thomas Jefferson University, 1015 Walnut St, Ste 115, Philadelphia, PA 19107 (

©2011Lippincott Williams & Wilkins, Inc.