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

OBJECTIVES:Transfusions are linked to adverse outcomes such as mortality, post-operative morbidity and increased costs. Patients who have undergone open spine surgery can experience high volume of blood loss and require transfusions due to the extensive muscle dissection associated with the procedure. Recently, there has been a focus on minimally invasive spine surgery techniques (MIS) that can minimize the exposure of tissue during spine surgery, which has resulted in the reduction of blood loss and related transfusions. METHODS: This retrospective study utilized the Premier Perspective ® database to compare costs of transfusion between patients who underwent 1-2 level MIS posterior lumbar interbody fusion (n=727) and open spine fusion (n=727) matched based on age and gender. A regression model was used to assess the impact of factors that affected the likelihood of transfusion. RESULTS: Patients who underwent MIS surgery had significantly fewer transfusions of perioperative autologous blood (1.8% vs. 6.2%), packed cells (5% vs. 10%) and platelets (0% vs. 0.6%) when compared to open fusion (p<0.05). The per patient transfusion cost for MIS was $252 lower than that of the open surgery. Per patient costs of antifibrinolytics, ESAs/hematinics and blood drainage were statistically lower for MIS fusion when compared to open fusion (p<0.05). The factors that were identified for the transfusion prediction model were surgery type, Charlson index, implanted screws, type/region of hospital, and type of insurance. The model showed that use of MIS fusion contributed most to the reduction in likelihood of transfusion when compared to the other variables (OR=0.441, p<0.0001). CONCLUSIONS: MIS fusion patients require fewer transfusions, thus resulting in lower mean transfusion costs when compared to open fusion patients. MIS fusion patients are less likely to receive a transfusion when compared to open fusion patients. A limitation was that pre-op Hct was excluded as a model variable, due to unavailability of data.

Conceptual models and empirical evidence suggest that hospitals that have a more developed culture of safety prioritize safety and integrate it into daily functioning throughout the organization. Singer et al examined the relationship of the hospital safety climate and hospital safety performance at different levels of organization. The study sample comprised providers at all levels from 91 hospitals who participated in the Patient Safety Climate Healthcare Organization (PSCHO) survey. This survey included questions regarding safety climate and demographics. Selected patient safety indicators (PSIs) were used for evaluation of safety performance. Data related to PSIs were collected after administration of the PSCHO, and predictive modeling examined the extent to which the climate measures predicted safety outcomes.The investigators found that higher levels of safety climate were associated with better safety performance. Dimensions such as fear of shame and fear of blame were associated with a significantly higher risk of experiencing PSI events, whereas organizational or work unit dimensions did not significantly predict PSI events. Better safety climate perceptions among frontline personnel were associated with a relative increase in the risk of experiencing PSI events.A 1 standard deviation improvement in aggregate hospital safety climate measure related to a 10% lower risk of experiencing a PSI and a 19% lower risk of experiencing a decubitus ulcer. Although these effects are small, the study demonstrates a positive relationship between hospital safety climate and performance. Measures such as fear of blame and fear of shame had a greater impact on safety climate, suggesting that psychological state may be linked to safety behaviors. Limitations include use of a crosssectional sample, confounders (eg, presence of a safety program, use of electronic medical record technology), and potential bias associated with surveying perceptions of safety versus direct observation. "Weekend Hospital Admission and Discharge for Heart Failure: Association With Quality of Care and Clinical Outcomes" (Am Heart J. 2009; 158(3):451-458),

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