Exploration of patient blood management metrics for emergency departments: a 4-year retrospective monocenter study

Abstract

Abstract Background Red blood cell (RBC) transfusions are essential in emergency departments (ED), but their practices lack standardization, often leading to inefficiencies and risks. Patient blood management is poorly developed in ED, particularly because of the diverse and acute nature of patients. Objectives Describe RBC transfusions in ED and develop a metric to benchmark RBC transfusion efficiency in the ED. Methods This retrospective study analyzed red blood cells transfusions at a French University Hospital (2020–2023). The yearly adjusted number of transfusions per ED-patient (YANTED) was calculated by adjusting the number of ED visits to exclude low-acuity cases. Metrics included transfusion timing, urgency level (immediate life-threatening emergency, life-threatening emergency, relative emergency and nonemergency), and the proportion of RBC transfused in the ED compared with hospital-wide transfusions. Results A total of 5,537 RBC units were transfused in the ED over four years, with a median YANTED of 16.3 (15.6-17.3) per 1,000 ED patients. Relative emergency transfusions accounted for 67% of all transfusions. Nighttime transfusions represented 45% of the total. The median time from RBC order to transfusion initiation was 182 min. The delivery and transfusion times for the immediate life-threatening emergency, life-threatening emergency patients were detailed, with 23% completed within the 30-minute threshold. ED accounted for 11% (95% CI: 10–12%) of total hospital transfusions. Conclusion Over a 4-year period, the YANTED was 16.7 (15.6–17.3) RBC units per 1,000 ED patients. Relative emergency prescriptions accounted for 67% of the transfusions and occurred mostly at night. Further studies should focus on how to decrease these indicators in the ED. Clinical trial number Not applicable.

Keywords

• Red blood cells
• Transfusion
• Emergency department
• Patient blood management