Reducing postoperative blood product usage and costs in cardiothoracic surgery: the implementation of a multispecialty perioperative care model incorporating a haemostasis checklist
Transfusion of blood products following cardiothoracic surgery represents a significant proportion of national blood product usage, has significant cost implications and is associated with increased 30-day mortality. Following identification of an increase in blood product use, we implemented a heal...
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| Format: | Article |
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/14/1/e002911.full |
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| author | Krishnaswamy Sundararajan Peter Hibbert Christopher Daniel Smith Adrian De Luca |
| author_facet | Krishnaswamy Sundararajan Peter Hibbert Christopher Daniel Smith Adrian De Luca |
| author_sort | Krishnaswamy Sundararajan |
| collection | DOAJ |
| description | Transfusion of blood products following cardiothoracic surgery represents a significant proportion of national blood product usage, has significant cost implications and is associated with increased 30-day mortality. Following identification of an increase in blood product use, we implemented a healthcare improvement initiative using a perioperative care model and establishment of a new multispecialty cardiothoracic surgery taskforce to further define and tackle the problem. The initiative incorporated a bundle of preoperative identification of high-risk patients, an intraoperative haemostasis checklist, a programme of unit education focussing on bleeding postbypass and use of thromboelastography and introduction of postoperative protocols for identification and escalation of bleeding. Following intervention, a 60% reduction in blood product use within the first 12 hours of cardiopulmonary bypass was observed. Red cell, cryoprecipitate and fresh frozen plasma usage were particularly reduced with 57%, 47% and 72% reductions, respectively, following intervention and similar results were maintained on repeat audit 1-year postintervention, with on average 84 fewer blood products used per 100 patients. This resulted in an estimated cost saving of AU$36 928 per 100 patients. This quality initiative was successful in overcoming traditional silos of care and describes how quality improvement methodology utilising a multispecialty and multidisciplinary approach can be applied to solve complex issues in the perioperative period. Here, we demonstrate a reproducible and sustainable model for reducing blood product use in the cardiothoracic perioperative population. |
| format | Article |
| id | doaj-art-7b5f42301afa482fa851b47254d820b6 |
| institution | Kabale University |
| issn | 2399-6641 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-7b5f42301afa482fa851b47254d820b62025-02-03T19:45:10ZengBMJ Publishing GroupBMJ Open Quality2399-66412025-01-0114110.1136/bmjoq-2024-002911Reducing postoperative blood product usage and costs in cardiothoracic surgery: the implementation of a multispecialty perioperative care model incorporating a haemostasis checklistKrishnaswamy Sundararajan0Peter Hibbert1Christopher Daniel Smith2Adrian De Luca3Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, AustraliaUniversity of South Australia, Adelaide, South Australia, AustraliaIntensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, AustraliaIntensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, AustraliaTransfusion of blood products following cardiothoracic surgery represents a significant proportion of national blood product usage, has significant cost implications and is associated with increased 30-day mortality. Following identification of an increase in blood product use, we implemented a healthcare improvement initiative using a perioperative care model and establishment of a new multispecialty cardiothoracic surgery taskforce to further define and tackle the problem. The initiative incorporated a bundle of preoperative identification of high-risk patients, an intraoperative haemostasis checklist, a programme of unit education focussing on bleeding postbypass and use of thromboelastography and introduction of postoperative protocols for identification and escalation of bleeding. Following intervention, a 60% reduction in blood product use within the first 12 hours of cardiopulmonary bypass was observed. Red cell, cryoprecipitate and fresh frozen plasma usage were particularly reduced with 57%, 47% and 72% reductions, respectively, following intervention and similar results were maintained on repeat audit 1-year postintervention, with on average 84 fewer blood products used per 100 patients. This resulted in an estimated cost saving of AU$36 928 per 100 patients. This quality initiative was successful in overcoming traditional silos of care and describes how quality improvement methodology utilising a multispecialty and multidisciplinary approach can be applied to solve complex issues in the perioperative period. Here, we demonstrate a reproducible and sustainable model for reducing blood product use in the cardiothoracic perioperative population.https://bmjopenquality.bmj.com/content/14/1/e002911.full |
| spellingShingle | Krishnaswamy Sundararajan Peter Hibbert Christopher Daniel Smith Adrian De Luca Reducing postoperative blood product usage and costs in cardiothoracic surgery: the implementation of a multispecialty perioperative care model incorporating a haemostasis checklist BMJ Open Quality |
| title | Reducing postoperative blood product usage and costs in cardiothoracic surgery: the implementation of a multispecialty perioperative care model incorporating a haemostasis checklist |
| title_full | Reducing postoperative blood product usage and costs in cardiothoracic surgery: the implementation of a multispecialty perioperative care model incorporating a haemostasis checklist |
| title_fullStr | Reducing postoperative blood product usage and costs in cardiothoracic surgery: the implementation of a multispecialty perioperative care model incorporating a haemostasis checklist |
| title_full_unstemmed | Reducing postoperative blood product usage and costs in cardiothoracic surgery: the implementation of a multispecialty perioperative care model incorporating a haemostasis checklist |
| title_short | Reducing postoperative blood product usage and costs in cardiothoracic surgery: the implementation of a multispecialty perioperative care model incorporating a haemostasis checklist |
| title_sort | reducing postoperative blood product usage and costs in cardiothoracic surgery the implementation of a multispecialty perioperative care model incorporating a haemostasis checklist |
| url | https://bmjopenquality.bmj.com/content/14/1/e002911.full |
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