ABSTRACT
Background/Case Studies: Decreased blood collection during the COVID-19 pandemic resulted in long-term red blood cell (RBC) shortages in the United States. To conserve RBCs, an existing passive alert system for auditing transfusions was modified to activate at a lower hemoglobin (HGB) threshold (6.5g/dL for stable nonbleeding inpatients) during a 9-month shortage at a 400-bed academic medical center. Study Design/Methods: This retrospective study compared the number of single unit RBC transfusions and pre-transfusion HGB levels among inpatients during 9 months of the intervention (Period 2, 06/01/2021- 2/28/2022) to the same period of the previous year (Period 1, 06/01/2020-2/28/2021) to determine whether RBC utilization changed during the intervention. Results/Findings: Overall full unit RBC transfusions to inpatients decreased by 15%. The incidence rate difference and incidence rate ratio of units transfused per 1000 patient-days significantly decreased (p = 0.029). The average pre-transfusion HGB level significantly decreased (p = 0.0002), largely due to significant decreases in HGB transfusion triggers for adult inpatient ward transfusions. Conclusion(s): Modification of the passive alert system was associated with significantly decreased RBC utilization during a long-term RBC shortage at a single center. Modification of transfusion criteria recommended by passive alerts may be a feasible option to decrease RBC utilization during long-term RBC shortages.