title: Outcomes of a Quality Improvement Initiative to Prevent Unnecessary Packed Red Blood Cell Transfusions Among Extremely Low Birth-Weight Neonates.
abstract: BACKGROUND
  Extremely low birth-weight (ELBW) infants frequently receive packed red blood cell (PRBC) transfusions. Recent studies have shown that more restrictive PRBC transfusion guidelines limit donor exposure and reduce transfusion-related costs without any increase in adverse clinical outcomes.
  
  
  OBJECTIVE
  We developed and implemented an evidence-based PRBC transfusion guideline for ELBW infants treated in our unit and then measured provider adherence to this guideline.
  
  
  METHODS
  We performed a retrospective review of all PRBC transfusions given to ELBW infants in 2012 (preguideline) and the first half of 2014 (postguideline). We identified the indication for each transfusion by reviewing physiological/laboratory data and the daily clinical note. We then determine whether each transfusion met criteria according to our new evidence-based guideline.
  
  
  RESULTS
  When extrapolating the newly developed protocol to 2012 data, less than 15% of transfusions among ELBW infants would have met the current evidence-based standard. Conversely, during the first 6 months of 2014, 61% of transfusions were administered in adherence to the guideline (P < 001). Using current cost estimates, this represents a projected cost savings of $31,000 in that 6-month period.
  
  
  CONCLUSIONS
  A multidisciplinary approach to improving PRBC transfusion practices results in potentially safer, more cost-effective care for ELBW infants.
  
  
  CONCLUSIONS
  Given the frequency, potential harms, and costs associated with PRBC transfusions in ELBW infants, it seems both feasible and important to pursue prospective clinical trials comparing permissive and restrictive approaches to transfusion in this vulnerable population.
authors.affiliation: Department of Nursing (Mss Beniwal, Kleven, Moody, and Schuning), Division of Neonatal Medicine (Mss Molin, Kantola, and Carlson and Drs Harris, Carey, and Ellsworth), Quality Academy (Ms Jain), and Division of Transfusion Medicine (Dr Buskirk), Mayo Clinic, Rochester, Minnesota.
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Beniwal
authors.forename: Karen L
authors.initials: KL
authors.lastname: Kleven
authors.forename: Leslie T
authors.initials: LT
authors.lastname: Moody
authors.forename: Brianna M
authors.initials: BM
authors.lastname: Molin
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Kantola
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Carlson
authors.forename: Virginia S
authors.initials: VS
authors.lastname: Schuning
authors.forename: Sneha
authors.initials: S
authors.lastname: Jain
authors.forename: Camille M
authors.initials: CM
authors.lastname: van Buskirk
authors.forename: Malinda N
authors.initials: MN
authors.lastname: Harris
authors.forename: William A
authors.initials: WA
authors.lastname: Carey
authors.forename: Marc A
authors.initials: MA
authors.lastname: Ellsworth
mesh_terms: D000751:Anemia, Neonatal / Q000191:economics / Q000628:therapy*; D001804:Blood Transfusion, Autologous / Q000191:economics / Q000592:standards*; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000191:economics*; D055317:Evidence-Based Practice / Q000191:economics / Q000592:standards*; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D017283:Neonatal Nursing / Q000191:economics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012189:Retrospective Studies