Blood transfusion in the Surgical ICU (SICU) is a commonly overused therapy. Worse outcomes correlate with higher rates of blood transfusions. In order to improve SICU patient care, we implemented an anemia management program (AMP). AMP aimed to reduce transfusions after the acute resuscitation phase by implementing a new anemia clinical practice guideline, which included: education, lower transfusion triggers, and minimizing excess phlebotomy. We hypothesized that AMP would decrease transfusions of packed red blood cells (PRBCs) and cost with no detriment in clinical outcomes.
Transfusion data was prospectively collected for all Surgical Critical Care Service (SCCS) patients treated in our 56-bed SICU between 7/2002 and 12/2003. AMP was implemented in a stepwise fashion over a six-month period to allow for the learning curve. Data was compared for the 6-month period before (7/02-12/02) and after (7/03-12/03) complete AMP implementation. Clinical outcomes were compared between groups using student’s t-test.
3475 patients were treated in the SICU over the 18-month study period (1289 in the first group and 996 in the second). PRBCs per patient transfused decreased from 18.0 to 14.3 (p=0.024) between the two time periods. Total PRBC cost decreased over the study period from $2.1 million to $1.2 million. There was no change in SICU length of stay (4.17 days vs. 4.35 days, ns).
Overall number and rates of PRBC transfusion decreased significantly after the implenetation of the anemia management program the SICU. Nearly $1 million dollars was saved on PRBC transfusions over a six-month period. No difference was seen in clincal outcomes.
Critical care units staffed by dedicated intensivists using evidence based medicine can improve resource utilization and reduce cost. Patient outcomes need to be evaluated simultaneously to avoid cutting costs at the detriment of patient care.
E.R. Haut, None.