Administering Blood Products Before Selected Interventional Radiology Procedures: Developing, Applying, and Monitoring a Standardized Protocol

• Published in: Journal of the American College of Radiology Vol. 14; no. 11; pp. 1438 - 1443
• Main Authors: Hoang, Nam S., Kothary, Nishita, Saharan, Seema, Rosenberg, Jarrett, Tran, Andrew A., Brown, Shaughnessy B., Hovsepian, David M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2017
• Subjects: Female; Guideline Adherence; guidelines; Humans; International Normalized Ratio; interventional radiology; Lean Six Sigma; Male; Plasma; Platelet Transfusion - standards; Practice Guidelines as Topic; Radiography, Interventional; transfusion; guidelines; transfusion; interventional radiology; Lean Six Sigma
• ISSN: 1546-1440; 1558-349X
• DOI: 10.1016/j.jacr.2017.07.026

To apply and monitor a single institution’s adherence to internally established guidelines for the preoperative administration of platelets and/or fresh frozen plasma (FFP) before a specified subset of minimally invasive interventional radiology (IR) procedures.
Beginning in December 2008, we implemented a set of restrictive guidelines for preoperative platelet and/or FFP administration before IR procedures at a single academic hospital. Basing our program on the methodology of Lean Six Sigma, we compared the number and appropriateness of transfusions between the months of January and October in 2008 (prepolicy), again in 2010 (postpolicy), and finally in 2015 (follow-up). Patients with a platelet count less than or equal to 50,000 or an international normalized ratio greater than or equal to 1.7 met criteria for receiving platelets or FFP, respectively, before their IR procedure. For all three periods, we compared the rates of transfusion, hemorrhagic complications, and proportion of appropriate versus inappropriate blood product administration (BPA) per our guidelines.
There was a significant increase in the number of appropriate BPAs between 2008 and 2010 from 58% to 76% (P = .021). Between 2010 and 2015, the rate trended up further, from 76% to 88% (P = .051). Overall, between 2008 and 2015, the improvement from 58% to 88% was significant (P < .001). The rate of hemorrhagic complications was extremely low in all three groups.
Restrictive guidelines for receiving platelets and FFP administrations before IR procedures can sustainably decrease the rate of overall BPA while increasing the proportion of appropriate BPA without impacting the rate of hemorrhagic complications.