Multifaceted approach to reducing unnecessary red blood cell utilization

Abbett, Sarah K.; Kaufman, Richard M.; Gustafson, Michael L.; Greenberg, Jack J.

doi:10.1016/j.hjdsi.2014.07.003

Cited by 5 publications

(16 citation statements)

References 47 publications

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“…Fourteen papers were selected for final inclusion (see Table 1) [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Study designs included before and after implementation studies (n = 3) [10, 20, 23], retrospective observational (n = 6) [11-13, 16, 18, 21] and prospective interventional studies (n = 5) [14,15,17,19,22].…”

Section: Characteristics Of Eligible Studiesmentioning

confidence: 99%

“…The majority of studies were conducted in Europe (n = 5) [13,17,19,20,22] or North America (n = 8 )[10-12, 14-16, 18, 23] with one paper from Australia [21]. Half of the included papers studied perioperative patient populations (50%, n = 7) [10,11,13,15,19,21,41], while 7% (n = 1) were focused on critical care [23], and 43% (n = 6) were unspecified [12,14,[16][17][18]20]. Outcome measures/results were reported in multiple formats.…”

Section: Characteristics Of Eligible Studiesmentioning

confidence: 99%

“…The barriers identified within each paper and the implementation strategies used to address them are summarised in Table 2. Eleven of the 39 CFIR constructs were identified as barriers to implementation including access to knowledge and information (n = 7) [10,12,13,16,18,21,22], knowledge and beliefs about the intervention (n = 7 )[12, 14-16, 19, 20, 23], tension for change (n = 6 ) [10,14,15,17,18,21], culture (n = 4) [12,15,20,23], structural characteristics (n = 4) [11,12,17,18], evidence strength and quality (n = 3) [12,16,20], available resources (n = 1) [18], complexity (n = 1) [18], engagement (n = 1) [18], peer pressure (n = 1) [20] and relative advantage (n = 1) [20]. Across the papers, a median of three barriers were reported, ranging between one and six.…”

Section: Barriersmentioning

confidence: 99%

“…Twenty-five different implementation strategies were identified in the included studies. The 10 most common implementation strategies were the following: conduct educational meetings (8 studies) [11, 12, 15, 17-19, 21, 23], audit and provide feedback (6 studies) [10-12, 15, 20, 23], develop educational materials (6 studies) [10,13,15,17,20,21], conduct local consensus discussions (6 studies) [10,13,17,18,20,23], develop and implement tools for quality monitoring (5 studies ) [10,11,16,19,21], remind clinicians (5 studies) [11,12,14,15,22], involve executive boards (4 studies) [12,18,20,22], distribute educational materials (3 studies) [16,20,22], facilitate relay of clinical data to providers (3 studies) [11,19,21], capture and share local knowledge (2 studies) [15,18]. Across the papers, a median of five implementation strategies were reported, ranging between one and seven.…”

Section: Implementation Strategiesmentioning

confidence: 99%

“…Many implementation strategies that support the implementation of PBM guidelines have been developed and utilised, but it is not clear which are the most effective [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Some examples of implementation strategies used to improve the uptake of PBM guidelines include using local consensus processes, audit and feedback, providing education and identifying and preparing champions [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. A systematic review by Tinmouth and colleagues found the use of behavioural implementation strategies to be effective at reducing blood product utilisation, but due to heterogeneity across studies, they could not make specific recommendations [25].…”

Section: Introductionmentioning

confidence: 99%

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Overcoming barriers to evidence-based patient blood management: a restricted review

et al. 2020

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Background: Blood transfusions are associated with a range of adverse patient outcomes, including coagulopathy, immunomodulation and haemolysis, which increase the risk of morbidity and mortality. Consideration of these risks and potential benefits are necessary when deciding to transfuse. Patient blood management (PBM) guidelines exist to assist in clinical decision-making, but they are underutilised. Exploration of barriers to the implementation and utilisation of the PBM guidelines is required. This study aimed to identify common barriers and implementation strategies used to implement PBM guidelines, with a comparison against current expert opinion. Methods: A restricted review approach was used to identify the barriers to PBM guideline implementation as reported by health professionals and to review which implementation strategies have been used. Searches were undertaken in MEDLINE/PubMed, CINAHL, Embase, Scopus and the Cochrane library. The Consolidated Framework for Implementation Research (CFIR) was used to code barriers. The Expert Recommendations for Implementing Change (ERIC) tool was used to code implementation strategies, and subsequently, develop recommendations based on expert opinion. Results: We identified 14 studies suitable for inclusion. There was a cluster of barriers commonly reported: access to knowledge and information (n = 7), knowledge and beliefs about the intervention ( = 7) and tension for change (n = 6). Implementation strategies used varied widely (n = 25). Only one study reported the use of an implementation theory, model or framework. Most studies (n = 11) had at least 50% agreement with the ERIC recommendations. Conclusions: There are common barriers experienced by health professionals when trying to implement PBM guidelines. There is currently no conclusive evidence to suggest which implementation strategies are most effective. Further research using validated implementation approaches and improved reporting is required.

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Section: Characteristics Of Eligible Studiesmentioning

confidence: 99%

Section: Characteristics Of Eligible Studiesmentioning

confidence: 99%

Section: Barriersmentioning

confidence: 99%

Section: Implementation Strategiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Overcoming barriers to evidence-based patient blood management: a restricted review

et al. 2020

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Implementing a Health System–wide Patient Blood Management Program with a Clinical Community Approach

Frank¹,

Thakkar²,

Podlasek³

et al. 2017

Anesthesiology

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Background Patient blood management programs are gaining popularity as quality improvement and patient safety initiatives, but methods for implementing such programs across multihospital health systems are not well understood. Having recently incorporated a patient blood management program across our health system using a clinical community approach, we describe our methods and results. Methods We formed the Johns Hopkins Health System blood management clinical community to reduce transfusion overuse across five hospitals. This physician-led, multidisciplinary, collaborative, quality-improvement team (the clinical community) worked to implement best practices for patient blood management, which we describe in detail. Changes in blood utilization and blood acquisition costs were compared for the pre– and post–patient blood management time periods. Results Across the health system, multiunit erythrocyte transfusion orders decreased from 39.7 to 20.2% (by 49%; P < 0.0001). The percentage of patients transfused decreased for erythrocytes from 11.3 to 10.4%, for plasma from 2.9 to 2.2%, and for platelets from 3.1 to 2.7%, (P < 0.0001 for all three). The number of units transfused per 1,000 patients decreased for erythrocytes from 455 to 365 (by 19.8%; P < 0.0001), for plasma from 175 to 107 (by 38.9%; P = 0.0002), and for platelets from 167 to 141 (by 15.6%; P = 0.04). Blood acquisition cost savings were $2,120,273/yr, an approximate 400% return on investment for our patient blood management efforts. Conclusions Implementing a health system-wide patient blood management program by using a clinical community approach substantially reduced blood utilization and blood acquisition costs.

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Preoperative anaemia screening and treatment: Barrier identification and implementation strategy mapping

Delaforce

Duff²,

Munday

et al. 2020

Preprint

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Background: Patients undergoing major surgery are at risk of significant blood loss and subsequent transfusion, which increases substantially if the patient has pre-existing anaemia. Preoperative anaemia screening and treatment pathways (PAST-P) outline recommended blood tests and treatment to ensure patient optimisation before surgery. Although documented success in using PAST-P to reduce transfusions and improve patient outcomes exists, the reporting quality of such studies is suboptimal, and it remains unclear what implementation strategies best support the implementation of PAST-P. This study uses qualitative methods to identify local barriers and maps them to recommended implementation strategies.Method: Maximum variation, purposive sampling was used to recruit a total of 15 participants, including a range of health professionals and patients. Qualitative data was collected using semi-structured interviews. Data analysis utilised a deductive approach informed by the Consolidated Framework for Implementation Research (CFIR) for barrier identification and the Expert Recommendations for Implementing Change (ERIC) for reporting recommended implementation strategies. The Action, Actor, Context, Target and Time (AACTT) framework assisted with conceptualisation and targeted strategy selection.Results: The analysis revealed ten barriers: external policy and incentives, patient needs and resources, structural characteristics, networks and communications, relative priority, available resources, access to knowledge and information, knowledge and beliefs about the intervention, self-efficacy and executing. ERIC strategies recommended to mitigate barriers are: conduct educational meetings, develop educational materials, distribute educational materials, access new funding, promote network weaving, organise clinician implementation team meetings, obtain and use patients/consumers/family feedback, involve patients/consumers/family members and conduct a local needs assessment.Conclusion: Five of ten identified barriers had strong recommendations, and nine implementation strategies were identified as being suitable to address them. Mapping the barriers and strategies using the ERIC framework on the basis of individual actor categories proved to be useful in identifying a pragmatic number of implementation strategies that may help in supporting the utilisation of the PAST-P, once it is launched at the study hospital.

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Multifaceted approach to reducing unnecessary red blood cell utilization

Cited by 5 publications

References 47 publications

Overcoming barriers to evidence-based patient blood management: a restricted review

Overcoming barriers to evidence-based patient blood management: a restricted review

Implementing a Health System–wide Patient Blood Management Program with a Clinical Community Approach

Preoperative anaemia screening and treatment: Barrier identification and implementation strategy mapping

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