Reducing adverse events associated with pediatric cardiac catheterization: A quality improvement project focusing on decreasing unnecessary blood transfusions

Abstract Objective: To describe interventions and outcomes of a quality improvement (QI) project to reduce red blood cell transfusion (RBCT) within 72 hours of pediatric cardiac catheterization. Methods: Using Plan-Do-Study-Act (PDSA) methodology we applied interventions including: 1. Intraprocedural - to reduce hemodilution, blood loss, and excessive anticoagulation, 2. Standardization of institutional transfusion criteria, and 3. “Hard stop” requiring QI team approval prior to elective RBCT. Primary outcome measures were frequency of RBCT from IMPACT quarterly reports and cases between transfusions (CBT). Length of stay (LOS) was a countermeasure. Characteristics of patients who did and did not receive RBCT were compared. Results: 698 pediatric cardiac catheterizations occurred between 4/2017-8/2023. Intraprocedural interventions did not alter frequency of RBCT or CBT. Standardized transfusion guidelines followed by the “hard stop” decreased RBCT frequency from 10% to 1.9% and increased CBT without increasing LOS. Patients requiring RBCT were younger (medians 0.31 vs 2.4 years), smaller (5.2 vs 11.8 kg) and had longer procedures (2.24 vs 1.57 hours) all p<0.001. Single ventricle patients were more likely to have RBCT than simple biventricular patients (14.1% vs 3.1%; RR = 4.57, 95% CI: 2.29–10.4; p < 0.001). Procedure type (diagnostic vs. intervention) and starting hemoglobin concentration were comparable between groups. Conclusion: Programmatic adherence to standardized peri-procedural transfusion guidelines successfully decreased RBCT without compromising patient care or increasing LOS. Younger age, lower weight, procedure length, and single ventricle physiology were all associated with RBCT risk.