Time Burden of Blood Transfusion.

Background:

Patients necessarily receive transfusions of packed red blood cells (PRBCs) in the course of ameliorating symptoms of anemia from a variety of causes, including chemotherapy-induced anemia, anemia of chronic disease, myelodysplastic syndrome, and chronic renal failure. Blood product availability is often at a critically low level in many regions throughout the US. Blood product administration is not without risk including: transfusion reaction and infection. In addition, routine blood transfusions require substantial time and resources from the healthcare practitioners, and the patients and their families. In the event of a transfusion reaction, even greater resources are expended. This study was designed to describe and quantify the time required for PRBC transfusion visits, the various events that take place during the visit, to describe PRBC transfusion reaction incidence in this population, and estimate providers’ labor and costs in providing PRBC transfusions.

Methods:

The study protocol was approved by the IRB of the INOVA Health System of Northern Virginia. Records of patients receiving PRBCs for any reason were retrospectively selected by working backwards from May 1, 2005 until 85 patient records were obtained. Data elements included:

• Primary diagnosis

• Number of PRBC units administered

• Adverse transfusion-related event(s)

• Procedures performed to treat the adverse events

• Transfusion visit time durations

Trained nurse data collectors reviewed transfusion and medical records of the selected patients. Adverse events were characterized according to whether the record either documented a reaction or information suggesting a reaction (e.g., furosemide or additional steroids administered during the visit).

Results:

Average patient age was 67.2 years and 79% were males. Most common diagnoses were Myelodysplastic Syndrome (MDS) (59%) and chemotherapy-induced anemia (22%). Most (65%) patients received no pre-medication. Seventy-eight percent of patients received 2 units of PRBCs. The blood was not filtered 81% of the time. Mean time to infuse the first and second units was 100.8 and 99.3 minutes, respectively. Mean time between the end of the first unit and initiation of the second unit was 21.3 minutes. Mean total time per patient from the start of the first unit to the completion of however much was transfused (1 or 2 units) was 190.8 minutes. Five percent of visits had documented reactions, and another 6% had evidence suggestive of a reaction, for a total visit-based incidence of 11%.

Conclusions:

PRBC transfusions in this predominately MDS population consumed substantial time for both the staff and patient. The above data does not include the time required for blood draw, type and cross, patient identification, insurance verification (all of which are substantial time commitments). There is also associated staff time for billing for the procedure. Additional time/motion analysis is ongoing to further document the total time burden involved. Adverse reactions requiring intervention occurred in approximately 1 in 10 patients. Transfusions have previously been shown to not be without risk. We have now shown them to be associated with a significant time burden. In the future, the use of non-transfusion alternatives should be investigated and encouraged.