title: Patient-centered approach to ensuring appropriateness of care through blood management.
abstract: BACKGROUND
  Concerns have been raised about the safety and efficacy of blood transfusions. Blood products are in demand and a decreasing supply is projected, with resource conservation a global concern. A consultant group determined that the transfusion rate at Mease Countryside Hospital was higher than an average baseline.
  
  
  METHODS
  A process-improvement project was initiated using a multidisciplinary team approach to improve blood utilization and ensure appropriateness in transfusion practice. The foundation of this project was to create new guidelines for transfusion; provide detailed education, communication, reporting, and feedback; and develop criteria to ensure compliance.
  
  
  RESULTS
  The mean monthly usage of red blood cell units per 1000 inpatient discharges between April 2010 and October 2011 was 321.4 compared with 212.0 for the 5 months after implementation. The mean monthly number of patients transfused per 1000 inpatient discharges from April 2010 to October 2011 was 135.2 compared with 90.2 after implementation. In both cases, this reduction was found to be statistically significant at a 95% confidence level (P = 0.000 in both respects).
  
  
  CONCLUSIONS
  The success of this project was the result of careful planning and execution, administrative support, physician leadership, and teamwork. Blood management includes strategies to avoid inappropriate transfusions and proactively treat anemia. Anemia management should be based on the patient's symptoms, laboratory values, and clinical assessment. Treatment of anemia should encompass a patient-centered approach, with the aim of promoting patient safety and minimizing the risk from exposure to blood products.
authors.affiliation: Laboratory Department, Morton Plant Mease BayCare Health System, Clearwater, Florida 33756, USA. Rita.king@baycare.org
authors.forename: Rita
authors.initials: R
authors.lastname: King
authors.forename: Mark
authors.initials: M
authors.lastname: Michelman
authors.forename: Vivian
authors.initials: V
authors.lastname: Curran
authors.forename: Jo
authors.initials: J
authors.lastname: Bean
authors.forename: Paul
authors.initials: P
authors.lastname: Rowden
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lindsey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000628:therapy; D017707:Erythrocyte Transfusion / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D058996:Quality Improvement