CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 164 AFRICA Creating blood conservation for a cardiothoracic surgical hospital: when you have to start from scratch! Cenk Indelen, Yesim Uygun Kizmaz, Atakan Erkilinc, Adile Ece Altinay, Aryeh Shander, Mehmet Kaan Kirali Abstract Background: This improvement report presents a hospital blood-management programme, a hospital-specific model that differs from patient blood managment and was aimed at improving operational standards of transfusion. We identified the challenges of the transfusion process and suggest practical strategies for improving them. The aim of this article was to investigate the effect of the programme on the transfusion of blood components. Methods: In January 2019, the programme was started to improve the transfusion process. The data before and after the start of the programme were compared. Frequency distribution was obtained for each variable for statistical analysis and the chi-squared test with continuity correction was used to compare these variables for the years 2018 and 2019. Results: Transfusion of total blood components decreased by 23.2%, fresh whole blood by 46.7%, fresh frozen plasma by 38.4%, pooled platelets by 14.0% and red blood cells by 9.66%. Autologous transfusion increased 11.7-fold. The emergency department (76.0%) and intensive care unit transfusion rate (9.26%) decreased significantly. Conclusion: This programme is an example for hospitals where patient blood management cannot be applied. The programme can be considered the first step for blood management and may be applied to blood management in institutions worldwide. The difficulty of blood supply and increased cost will increase the importance of hospital blood-management programmes in the coming years. Keywords: autologous, blood conservation, blood donation, patient blood management, quality management Submitted 3/3/22; accepted 15/8/22 Published online 19/9/22 Cardiovasc J Afr 2023; 34: 164–168 www.cvja.co.za DOI: 10.5830/CVJA-2022-044 Transfusion of blood components is associated with complications and high costs, which have introduced concerns about this therapy.1,2 Decisions about transfusion are determined by guidelines, physicians’ habits and hospital transfusion policies, which have not incorporated these issues.3-6 Patient blood management (PBM), a patient-centred approach, is a multidisciplinary, evidence-based, patient-personalised approach with known clinical results.7-10 Implementation of PBM often faces difficulties in healthcare services and from clinicians’ resistance. In this article we ask: What can be done if implementing PBM meets significant resistance? How can the transfusion processes be improved? Does a transfusion quality-improvement programme affect blood-component use in a hospital? On 1 January 2019, we instituted a programme called hospital blood management (HBM), which was created to meet our needs. It was directed towards quality improvement, patient safety and awareness of transfusion costs and adverse events. There is no hospital blood management keyword in the literature. We have used this concept to focus on hospital staff performance, not patient transfusion requirements, with strict application of defined methodology. The aim of this article was to present the results from implementation of this programme in our hospital. Methods Kosuyolu High Specialization Training and Research Hospital is a tertiary-care facility with 465 beds. The hospital specialises in thoracic and cardiovascular procedures and has performed the second highest number of heart and lung transplantations in Turkey. This study was a retrospective review of the results of the transfusion quality programme, introduced in 2019, compared with transfusion data from 2018. Institutional ethics committee approval was received on 8 May 2020, with the number 2020.4/04 304. On 1 November 2018, a programme was presented to the hospital management to improve blood-component management at our centre. A core team was set up that was responsible for holding didactic presentations, training, data monitoring and auditing the programme. The team included a cardiovascular surgeon, an anaesthesiology/critical care doctor, a transfusion doctor, and haemovigilance nurses. Department of Cardiovascular Surgery, Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey Cenk Indelen, MD, cindelen@gmail.com Mehmet Kaan Kirali, MD Department of Anesthesiology and Reanimation, Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey Cenk Indelen, MD, cindelen@gmail.com Atakan Erkilinc, MD Adile Ece Altinay, MD Department of Infection Disease and Microbiology, Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey Yesim Uygun Kizmaz, MD Department of Anesthesiology and Reanimation, Englewood Hospital, New Jersey, USA Aryeh Shander, MD
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