Experience of a network of transfusion coordinators for blood conservation (Ontario Transfusion Coordinators [ONTraC]).
BACKGROUND
The experiences of the development of a provincial program to promote blood conservation are herein reported.


METHODS
Transfusion coordinators were placed in 23 Ontario hospitals. Anonymized laboratory and clinical information was collected in a defined number of all consecutive patients admitted for three designated procedures: knee arthroplasty, abdominal aortic aneurysm (AAA), and coronary artery bypass graft (CABG) surgery (n approximately 1100, 300, and 300 at each time period, respectively).


RESULTS
Considerable interinstitutional variation was observed in the proportion of patients who received transfusions. At 12 months, and over the 24-month period of the project, most hospitals demonstrated decreased use of allogeneic blood; at 12 months an approximate 24 percent reduction in patients undergoing knee surgery, 14 percent in AAA, and 23 percent in CABG was obtained. In addition, patients who received transfusions received less allogeneic blood. Patients who did not receive allogeneic transfusions had lower postoperative infection rates (p < 0.05) and length of stay (p < 0.0001); allogeneic transfusion was an independent predictor of increased length of stay. The main blood conservation measures employed during this time were education, preoperative autologous donation, erythropoietin, and cell salvage.


CONCLUSIONS
The implementation of a provincial network of transfusion coordinators was feasible and allogeneic transfusion rates declined over the period the program has been in place.
Freedman
John
J
St Michael's Hospital, Toronto Platelet Immunobiology Group, Department of Public Health Sciences, EPI-STAT Research, Inc., University of Toronto, Toronto, Ontario, Canada. freedman@smh.toronto.on.ca
Luke
Katherine
K
Escobar
Michael
M
Vernich
Lee
L
Chiavetta
Jo Anne
JA
D017544:Aortic Aneurysm, Abdominal; D019645:Arthroplasty, Replacement, Knee; D001771:Blood Banks / Q000458:organization & administration*; D001782:Blood Donors; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007902:Length of Stay; D009864:Ontario; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D000078329:Workforce; D000094902:Blood Banking / Q000379:methods*
D006454:Hemoglobins