Sustainability and cost avoidance of reduced inappropriate red blood cell transfusion at community hospitals in Niagara Region: a follow-up analysis on a quality improvement initiative
Bibliographic record
Abstract
BACKGROUND: Inappropriate packed red blood cell (pRBC) transfusions increase patient risk and healthcare costs. Initial audits at Niagara Health (Ontario, Canada) revealed only 85% and 54% compliance with Choosing Wisely Canada guidelines for pre-transfusion hemoglobin (≤80 g/L) and single-unit transfusion, respectively. METHODS: We conducted a nonrandomized, interrupted time-series Quality Improvement Project (QIP) using the Model for Improvement. Interventions included technologist-led prospective screening of pRBC orders, policy updates, and educational campaigns. Outcome measures were rates of inappropriate transfusions based on hemoglobin and single-unit criteria; balancing measures included transfusion-related adverse events. Sustainability was assessed using Statistical Process Control charts. Cost analysis estimated savings using an activity-based cost of $C1500 per pRBC unit. RESULTS: Initial implementation improved compliance to 90% (pre-transfusion hemoglobin) and 71% (single-unit) within three months. Extended analysis (2021-2024) demonstrated sustained rates of 90% and 77%, respectively. At the St. Catharines Site, monthly median transfusions decreased from 273 to 173 units, yielding a 56% reduction in RBC utilization and 44% cost savings amounting to $C5052000. CONCLUSIONS: Technologist-led screening achieved sustained improvements in transfusion appropriateness, leading to substantial cost savings. Variability across sites underscores the need for further research on contextual factors influencing future QIP success.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".