The impact of organisational change on transfusion practices in perioperative care: an analysis of blood product use following the merger of three London cardiac surgery units to form the Barts Heart Centre

Sibtain Anwar; Laura Green; Jackie Cooper; Miles Curtis; Neil Roberts; Julie Sanders; Marie Scully; Victoria Stables; Ben O'Brien

doi:10.7861/fhj.2019-0014

The impact of organisational change on transfusion practices in perioperative care: an analysis of blood product use following the merger of three London cardiac surgery units to form the Barts Heart Centre

Future Healthc J. 2020 Feb;7(1):72-77. doi: 10.7861/fhj.2019-0014.

Authors

Sibtain Anwar¹, Laura Green², Jackie Cooper³, Miles Curtis⁴, Neil Roberts⁴, Julie Sanders⁵, Marie Scully⁶, Victoria Stables⁶, Ben O'Brien¹

Affiliations

¹ Barts Health NHS Trust, London, UK, Barts and the London School of Medicine and Dentistry, London, UK, William Harvey Research Institute, London, UK and Outcomes Research Consortium, Cleveland, USA.
² Barts Health NHS Trust, London, UK, Queen Mary University of London, London, UK and NHS Blood and Transplant, London, UK.
³ William Harvey Research Institute, London, UK.
⁴ Barts Health NHS Trust, London, UK.
⁵ Barts Health NHS Trust, London, UK and William Harvey Research Institute, London, UK.
⁶ University College London Hospitals NHS Foundation Trust, London, UK.

Abstract

Objectives: In 2015, three London cardiac centres, with different transfusion infrastructure support, merged to form the Barts Heart Centre. We describe the impact on transfusion rate, blood usage and interoperator variation.

Design: Data was collected on all adult patients undergoing cardiac surgery during 2014 as well as 2016, using the National Institute Cardiovascular Outcomes Research (NICOR) data set.

Measurements and main results: Over the two time periods, a total of 3,647 cardiac procedures were performed (1,930 in 2014 and 1,717 in 2016). There were no significant differences in type of surgery or patient comorbidity between the two epochs of time. Overall, red blood cell transfusion at 24 hours and until hospital discharge reduced significantly in 2016 (odds ratio 0.77; 95% confidence interval 0.68-0.89; p=0.0002). Interoperator variability (adjusted for comorbidities) reduced after merger from standard deviation 0.394 (standard error (SE) 0.096) to 0.269 (SE 0.082), p=0.001.

Conclusion: Clinical and organisational factors can improve transfusion service.

Keywords: Patient blood management; cardiac surgery; transfusion services.