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Transfusion - 2023 - Delaforce - Results from a type two hybrid‐effectiveness study to implement a preoperative anemia and1.40 MB
Published VersionCC BY-NC V4.0, Open Access
Journal article
Results from a type two hybrid-effectiveness study to implement a preoperative anemia and iron deficiency screening, evaluation, and management pathway
Transfusion, Vol.63(4), pp.724-736
2023
PMID: 36807584
Abstract
Background
Implementation of pathways to screen surgical patients for preoperative anemia and iron deficiency remains limited. This study sought to measure the impact of a theoretically informed, bespoke change package on improving the uptake of a Preoperative Anemia and Iron Deficiency Screening, Evaluation, and Management Pathway.
Study Design and Methods
Pre-post interventional study using a type two hybrid-effectiveness design evaluated implementation. Four hundred (400) patient medical record reviews provided the dataset (200 pre- and 200-post implementation). The primary outcome measure was compliance with the pathway. Secondary outcome measures (clinical outcomes) were anemia on day of surgery, exposure to a red blood cell (RBC) transfusion, and hospital length of stay. Validated surveys facilitated data collection of implementation measures. Propensity score-adjusted analyses determined the effect of the intervention on clinical outcomes, and a cost analysis determined the economic impact.
Results
For the primary outcome, compliance improved significantly post-implementation (Odds Ratio 10.6 [95% CI 4.4–25.5] p < .000). In secondary outcomes, adjusted analyses point estimates showed clinical outcomes were slightly improved for anemia on day of surgery (Odds Ratio 0.792 [95% CI 0.5–1.3] p = .32), RBC transfusion (Odds Ratio 0.86 [95% CI 0.41–1.78] p = .69) and hospital length of stay (Hazard Ratio 0.96 [95% CI 0.77–1.18] p = .67), although these were not statistically significant. Cost savings of $13,340 per patient were realized. Implementation outcomes were favorable for acceptability, appropriateness, and feasibility.
Conclusion
The change package significantly improved compliance. The absence of a statistically significant change in clinical outcomes may be because the study was powered to detect an improvement in compliance only. Further prospective studies with larger samples are needed. Cost savings of $13,340 per patient were achieved and the change package was viewed favorably.
Details
- Title
- Results from a type two hybrid-effectiveness study to implement a preoperative anemia and iron deficiency screening, evaluation, and management pathway
- Authors
- Alana Delaforce (Corresponding Author) - University of Newcastle AustraliaShannon Farmer (Author) - Royal Perth HospitalJed Duff (Author) - University of Newcastle AustraliaJudy Munday (Author) - Queensland University of TechnologyKristin Miller (Author) - Mater Health ServicesLynne Glover (Author) - Mater Health ServicesChris Corney (Author) - Mater Health ServicesGareth Ansell (Author) - Mater Health ServicesNaadir Gutta (Author) - Mater Health ServicesHaitham Tuffaha (Author) - The University of QueenslandJanet Hardy (Author) - Mater Health ServicesCameron Hurst (Author) - QIMR Berghofer Medical Research Institute
- Publication details
- Transfusion, Vol.63(4), pp.724-736
- Publisher
- Wiley-Blackwell Publishing, Inc.
- Date published
- 2023
- DOI
- 10.1111/trf.17287
- ISSN
- 1537-2995; 0041-1132
- PMID
- 36807584
- Copyright note
- © 2023 The Authors. Transfusion published by Wiley Periodicals LLC on behalf of AABB. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
- Grant note
- Mater Foundation
- Organisation Unit
- School of Health - Nursing
- Language
- English
- Record Identifier
- 99991064602621
- Output Type
- Journal article
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- Hematology
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