Presentation Details
| Transfusion Trends in the Obstetric Population with Analysis of a Soft Stop Transfusion EMR Alert Maren Plant1, Sophia Cordes1, Caroline Bereuter1, Jaclyn Phillips1, Xiomara Fernandez2, Homa Ahmadzia1. 1Department of Obstetrics and Gynecology, George Washington University, Washington, DC, USA.2Department of Pathology, George Washington University, Washington, DC, USA |
Abstract
Background: Blood product transfusion plays an important role in treating obstetric hemorrhage, which is the leading cause of maternal mortality worldwide. Obstetric transfusion practices are varied, and research in this area is limited. The recent advent of EMR soft stop transfusion alerts has the potential to limit unnecessary transfusion in patients. Analysis of overall transfusion trends in the obstetric population and with respect to EMR alerts may inform further research and guidelines. Objective(s): This study aimed to analyze transfusion trends in the obstetric patient population at a large university hospital before and after implementation of a soft stop EMR alert notifying providers before transfusing patients with a hemoglobin greater than 8 g/dL. Study Design: The study included 17,744 patients who delivered at the hospital between February 2015 and December 2022. The EMR soft stop alert was implemented in February 2022. Patients were split into two cohorts–those prior to and those following the date of alert implementation. Records of hematocrit values and transfusion were pulled from the electronic medical record. Transfusion data included packed red blood cells, thawed plasma, and platelets. Means and medians were calculated for hematocrit drawn closest to admission and closest to discharge, and by the number of units received. Using a two-tailed unpaired t-test for samples with unequal variance, a p-value was calculated for number of units transfused in cohorts 1 versus 2. Results: Of the 17,744 patients included in the study, 208 received postpartum transfusions of pRBCs, FFP, and/or platelets. Average estimated blood loss (EBL) was 1996 ± 1505 mL (range 150-1505). 170 participants were included in cohort 1 from February 2015-January 2022. 38 participants were included in cohort 2 (following alert implementation) from February 2022-December 2022. The average number of units transfused in Cohort 1 vs. Cohort 2 was 2.9 vs. 2.0 units (p=0.039). Cohorts 1 and 2 had an equal average hematocrit closest to discharge. The average hematocrit closest to discharge for the total population was 27.2% ± 5.0. Broken down by blood product units received, the average hematocrit closest to discharge for the total population was 27.1% ± 4.7, 27.2% ± 5.2, and 27.4% ± 5.1 for 1 unit, 2 units, and 3+ units respectively (Table 1). Conclusion(s): Our findings demonstrate a statistically significant decrease in the total number of units transfused after the EMR soft stop was implemented. While many factors influence the decision to transfuse, this alert may correlate with a reduction in the number of transfusions in obstetric patients. Overall, more research is needed to guide transfusion practices, including analysis of intrapartum transfusion with respect to postpartum transfusion.
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