Quality improvement project led to substantial reduction in transfusions for TJR

NEW ORLEANS — Implementing a targeted program to improve health care and value that was associated with a state joint arthroplasty in Michigan led to a substantial reduction in blood transfusion rates for total knee arthroplasty and total hip arthroplasty in the 3 years after the program was put in place, a presenter said.

At the American Academy of Orthopaedic Surgeons Annual Meeting, Brian R. Hallstrom, MD, of Ann Arbor, Michigan, who is co-director of the Michigan arthroplasty registry, said blood transfusion rates in Michigan dropped to 1.6% overall in 2017 for all joint replacement surgery because of the recent program.

“There are some hospitals that did not give a single transfusion for an elective primary last year,” he said.

Tranexamic acid (TXA) use in the state also changed dramatically. It increased from 5% initially to 91% usage in 2017, Hallstrom said. At the inception of the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), transfusion rates for TKA ranged from 6% to 42% and for THA they ranged from 2% to 28%.

“TXA was used rarely,” Hallstrom said.

The most important and powerful quality improvement tool with MARCQI is the Collaborative Meeting, he said. It was in that setting that the MARCQI Transfusion Reduction Program, which launched in November 2013, was conceived. Sharing best practices, identifying variations in care delivery and other information about the approximate 189,000 joint replacement cases from 516 surgeons at 67 sites, led to implementation of the transfusion program.

“At that meeting, we recommended that sites screen for and treat preoperative anemia,” Hallstrom said, noting hospitals were also offered some transfusion guidelines from the American Red Cross to follow, which included giving 1 unit of blood at a time and only giving blood when Hgb was less than 8g/dL.

“As we got more data and learned more about TXA in Michigan, we then added that explicitly to our recommendations in 2014,” he said.

“Improving value is becoming more and more important. The advantage of these type programs and each of the programs that we pursued as part of MARCQI is that, using registry data, we can really affect both sides of the value equation. Transfusions are expensive. They have complications associated with them, and our estimate from 2016 is the savings across Michigan is at least $4 million,” Hallstrom said. – by Susan M. Rapp

Reference s :

Hallstrom BR. Symposium H. What can a registry do for me? Identify clinical best practices and improvement patient care: Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQUI): Eliminating unnecessary transfusion in Michigan. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 6-10, 2018; New Orleans.

www.marcqui.org

Disclosure: Hallstrom reports he receives partial salary support from Blue Cross/Blue Shield for the work he discussed and performs some health care consulting and is a board or committee member of the AJRR.