Patient blood management initiative significantly reduces transfusions and hospital stays for cranial vault surgery

A quality improvement project through our department’s ongoing patient blood management (PBM) initiative has significantly reduced blood transfusions for children undergoing cranial vault surgery at UF Health.

The newly implemented intraoperative protocols have also been able to decrease hospital length of stay for these patients, which is also associated with better patient outcomes.

The combination of fewer transfusions and shorter hospital stays has resulted in costs savings and additional revenue for UF Health.

Before this initiative, 100% of children undergoing cranial vault surgery at UF Health were being transfused with allogeneic blood products. Experts say 40% to 60% of blood transfusions are unnecessary and can put patients at risk for infections and other complications associated with introducing a foreign substance to the body.

With the implementation of the protocol, the transfusion rate fell to 14% in a small sample of patients. Cranial vault surgery is a major procedure typically performed in neonates and young children to allow the brain to expand normally and restore head shape.

“We have an excellent team devoted to this project from the departments of Pediatric Neurosurgery, Plastic Surgery, Shands Nursing, Perfusion, and Anesthesiology,” said Mary Jane Michael, RN, MS, CCRC, Manager of Clinical Research, who runs the Practicing Excellence in Transfusion (PETGators) with Bruce Spiess, MD, FAHA, Professor of Anesthesiology and Associate Chair for Research.

Future research in these patients may include evaluating cell salvage and researching cell membrane fragility.

Patient blood management is an evidence-based multidisciplinary initiative with three pillars: optimizing red cell mass, minimizing bleeding, and optimizing tolerance to anemia. Each pillar is applied to preoperative, intraoperative, and postoperative settings to improve patient outcomes.

The current project implemented PBM in the intraoperative setting by:

  • Developing an evidence-based standardized protocol for PBM in cranial vault surgery
  • Educating a dedicated surgical team
  • Implementing a PBM checklist to be completed immediately before anesthesia induction
  • Evaluating the implementation of the checklist for this surgery

In February of 2022, the University of Florida Department of Anesthesiology will be hosting the very first Patient Blood Management Conference, Torniquetting Transfusion: The Future of Patient Blood Management. The conference will be held February 20 – 23, at the World Center Marriott in Orlando, FL. Directed by Dr. Bruce Spiess, and with many of our professors speaking, the Tourniquetting Transfusion Conference will examine cutting edge research and developments regarding blood functions, oxygen delivery, microcirculation, and inflammation.