Decreasing packed red blood cell (pRBC) transfusions in neonates through quality improvement

Objective: Using a quality improvement (QI) framework, we aimed to reduce the number of transfusions of packed red blood cells (pRBC) through adoption of evidence based more restrictive transfusion thresholds. Methods: A SMART aim was developed to decrease pRBC transfusions in infants less than 35 weeks gestation at birth by approximately 25 percent from the baseline rate of 28/1000 patient days by 12/31/2024 through implementation of a transfusion protocol with more restrictive thresholds. Five sequential Plan-Do-Study-Act cycles incorporated guidelines to decrease transfusions. Statistical Process Control charts (QI Macros SPC Software for Microsoft Excel) were used to track time-ordered data. Results: pRBC transfusions decreased from 28/1000 patient days to 18.3/1000 patient days below the target of 21/1000 patient days over a 16-month period. Conclusion: A transition to more restrictive transfusion thresholds was done successfully in our unit with a robust framework leading to fewer pRBC transfusions.