title: Transfusion rate as a quality metric: is blood conservation a learnable skill?
abstract: BACKGROUND
  Between January 2008 and December 2012, a multicenter quality collaborative initiated a focus on blood conservation as a quality metric, with educational presentations and quarterly reporting of institutional-level perioperative transfusion rates and outcomes. This prospective cohort study was undertaken to determine the effect of that initiative on transfusion rates after isolated coronary artery bypass grafting (CABG).
  
  
  METHODS
  Between January 1, 2008, and December 31, 2012, 30,271 patients underwent isolated CABG in Michigan. Evaluated were annual crude and adjusted trends in overall transfusion rates for red blood cells (RBCs), fresh frozen plasma (FFP), and platelets, and in operative death.
  
  
  RESULTS
  Transfusion rates continuously decreased for all blood products. RBC use decreased from 56.4% in 2008 (baseline) to 38.3% in 2012, FFP use decreased from 14.8% to 9.1%, and platelet use decreased from 20.5% to 13.4% (ptrend < 0.001 for all). A significant reduction occurred in deep sternal wound infection, reoperation for bleeding, renal failure, prolonged ventilation, initial ventilator time, and intensive care unit duration. The percentage of patients discharged home significantly increased (ptrend < 0.001). Mortality rates did not differ significantly (ptrend = 0.11).
  
  
  CONCLUSIONS
  In a multicenter quality collaborative, increased attention to transfusion-related outcomes and blood conservation techniques, coincident with regular reporting and review of perioperative transfusion rates as a quality metric, was associated with a significant decrease in blood product utilization. These reductions were concurrent with significant improvement in most perioperative outcomes. This intervention was also safe, as it was not associated with any increases in mortality.
authors.affiliation: Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Michigan. Electronic address: gpaone1@hfhs.org.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.affiliation: Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Robert
authors.initials: R
authors.lastname: Brewer
authors.affiliation: Section of Health Services Research and Quality, Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Likosky
authors.affiliation: Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan.
authors.forename: Patricia F
authors.initials: PF
authors.lastname: Theurer
authors.affiliation: Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan.
authors.forename: Gail F
authors.initials: GF
authors.lastname: Bell
authors.affiliation: Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Cogan
authors.affiliation: Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prager
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D057668:Bloodless Medical and Surgical Procedures / Q000193:education*; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019984:Quality Indicators, Health Care
keywords: 23