Reducing unnecessary red blood cell transfusion in hospitalised patients

Mehta, Nishila; Murphy, Michael; Kaplan, Lawrie; Levinson, Wendy

doi:10.1136/bmj.n830

Cited by 8 publications

(12 citation statements)

References 22 publications

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“…20,98,99 Although the chapter on trials to determine optimal thresholds for RBC transfusion should be closed by now 100 and physicians across many specialties should have realized that adherence to more restrictive thresholds is recommended, practice continues to show little or incomplete compliance with current guidelines. 24,[101][102][103] It is, therefore, not surprising that the rate of nonindicated transfusions is estimated to be 60%. 23 Despite this enormous overuse, Roberts et al 19 request a continuous expansion and optimization of national transfusion services, the global implementation of evidence-based strategies for blood availability, and the governmental support and finances to reach these goals.…”

Section: How "3 Domains Of Waste" Impede the Global Adoption Of Pbm A...mentioning

confidence: 99%

Patient Blood Management: Improving Outcomes for Millions While Saving Billions. What Is Holding It Up?

Hofmann

Shander

Blumberg

et al. 2022

Anesthesia &Amp; Analgesia

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Patient blood management (PBM) offers significantly improved outcomes for almost all medical and surgical patient populations, pregnant women, and individuals with micronutrient deficiencies, anemia, or bleeding. It holds enormous financial benefits for hospitals and payers, improves performance of health care providers, and supports public authorities to improve population health. Despite this extraordinary combination of benefits, PBM has hardly been noticed in the world of health care. In response, the World Health Organization (WHO) called for its 194 member states, in its recent Policy Brief, to act quickly and decidedly to adopt national PBM policies. To further support the WHO’s call to action, this article addresses 3 aspects in more detail. The first is the urgency from a health economic perspective. For many years, growth in health care spending has outpaced overall economic growth, particularly in aging societies. Due to competing economic needs, the continuation of disproportionate growth in health care spending is unsustainable. Therefore, the imperative for health care leaders and policy makers is not only to curb the current spending rate relative to the gross domestic product (GDP) but also to simultaneously improve productivity, quality, safety of patient care, and the health status of populations. Second, while PBM meets these requirements on an exceptional scale, uptake remains slow. Thus, it is vital to identify and understand the impediments to broad implementation. This includes systemic challenges such as the so-called “waste domains” of failure of care delivery caused by malfunctions of health care systems, failure of care coordination, overtreatment, and low-value care. Other impediments more specific to PBM are the misperception of PBM and deeply rooted cultural patterns. Third, understanding how the 3Es—evidence, economics, and ethics—can effectively be used to motivate relevant stakeholders to take on their respective roles and responsibilities and follow the urgent call to implement PBM as a standard of care.

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Section: How "3 Domains Of Waste" Impede the Global Adoption Of Pbm A...mentioning

confidence: 99%

Patient Blood Management: Improving Outcomes for Millions While Saving Billions. What Is Holding It Up?

Hofmann

Shander

Blumberg

et al. 2022

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

show abstract

“…The practice of transfusion overuse has been a concern in multiple other countries, including the United Kingdom, Spain, Northern Ireland, and South Africa [5][6][7][8][9][10]. Transfusion overuse can make patients prone not only to immunological reactions, including hemolysis and acute lung injury, but also to circulatory volume overuse and acute heart failure [11]. In 2011, there were 30 casualties reported among transfusion recipients in the United States, and among all associated risks, transfusion-related acute lung injury and volume overload have been significant causes of morbidity [12,13].…”

Section: Blood Transfusion and Challengesmentioning

confidence: 99%

“…The drawbacks of transfusion overuse have been long identified by authorities and have instigated much interest in institution-based and national patient blood management initiatives within the United States [ 11 , 12 , 14 , 15 ]. Additionally, efforts have been entrusted with clinical studies aiming to optimize blood transfusion practices.…”

Section: Introductionmentioning

confidence: 99%

Clinicians’ Perceptions of an Artificial Intelligence–Based Blood Utilization Calculator: Qualitative Exploratory Study

Choudhury¹,

Asan²,

Medow³

2022

JMIR Hum Factors

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Background According to the US Food and Drug Administration Center for Biologics Evaluation and Research, health care systems have been experiencing blood transfusion overuse. To minimize the overuse of blood product transfusions, a proprietary artificial intelligence (AI)–based blood utilization calculator (BUC) was developed and integrated into a US hospital’s electronic health record. Despite the promising performance of the BUC, this technology remains underused in the clinical setting. Objective This study aims to explore how clinicians perceived this AI-based decision support system and, consequently, understand the factors hindering BUC use. Methods We interviewed 10 clinicians (BUC users) until the data saturation point was reached. The interviews were conducted over a web-based platform and were recorded. The audiovisual recordings were then anonymously transcribed verbatim. We used an inductive-deductive thematic analysis to analyze the transcripts, which involved applying predetermined themes to the data (deductive) and consecutively identifying new themes as they emerged in the data (inductive). Results We identified the following two themes: (1) workload and usability and (2) clinical decision-making. Clinicians acknowledged the ease of use and usefulness of the BUC for the general inpatient population. The clinicians also found the BUC to be useful in making decisions related to blood transfusion. However, some clinicians found the technology to be confusing due to inconsistent automation across different blood work processes. Conclusions This study highlights that analytical efficacy alone does not ensure technology use or acceptance. The overall system’s design, user perception, and users’ knowledge of the technology are equally important and necessary (limitations, functionality, purpose, and scope). Therefore, the effective integration of AI-based decision support systems, such as the BUC, mandates multidisciplinary engagement, ensuring the adequate initial and recurrent training of AI users while maintaining high analytical efficacy and validity. As a final takeaway, the design of AI systems that are made to perform specific tasks must be self-explanatory, so that the users can easily understand how and when to use the technology. Using any technology on a population for whom it was not initially designed will hinder user perception and the technology’s use.

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“…Blood products are a limited and costly resource for our healthcare systems. Red blood cell transfusions are an essential treatment under certain circumstances, but they are often overused and can lead to patient harm when they are not warranted (Mehta et al 2021).…”

Section: Introductionmentioning

confidence: 99%

Overuse of Tests and Treatments: Has Canada Made Progress?

Costante¹,

Chen²,

Dudevich³

et al. 2023

hcq

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Overuse of healthcare services is a complex issue. Also known as low-value care, these are tests, treatments and procedures that are commonly ordered despite clear evidence that they do not help with patient care and may even cause harm. National clinician societies have developed over 450 Choosing Wisely Canada (CWC) recommendations to spur conversation about what is appropriate and necessary treatment. The latest report from the Canadian Institute for Health Information and CWC measured the trends and variation in the use over time of tests and treatments related to 12 CWC recommendations (CIHI 2022). Reductions in overuse were observed in eight of the 12 tests and treatments examined; findings for two of these measures -chronic benzodiazepine use and red blood cell transfusions -are highlighted. Despite some progress on reducing overuse, there remains considerable room for improvement in the appropriate and judicious use of tests and treatments in Canada.

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Reducing unnecessary red blood cell transfusion in hospitalised patients

Cited by 8 publications

References 22 publications

Patient Blood Management: Improving Outcomes for Millions While Saving Billions. What Is Holding It Up?

Patient Blood Management: Improving Outcomes for Millions While Saving Billions. What Is Holding It Up?

Clinicians’ Perceptions of an Artificial Intelligence–Based Blood Utilization Calculator: Qualitative Exploratory Study

Overuse of Tests and Treatments: Has Canada Made Progress?

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