Reduction in red blood cell transfusion associated with engagement of the ordering physician.

BACKGROUND: Data on red blood cell (RBC) transfusion in the United States show variation in practice and overprescribing or overdosing is considered to be prevalent. Education or restrictive interventions could modify practice. STUDY DESIGN AND METHODS: RBC transfusion and mortality rates were recorded in a single institution over a 15-year period. The first 3 years were used as a baseline. Education measures were used to influence practice for 3 years followed by a 9-year period when questionable RBC orders in nonbleeding inpatients resulted in prospective physician notification for potential modification. Physician notification was done by blood bank technologists with transfusion medicine physician support, if needed. Pretransfusion hemoglobin levels of more than 9 g/dL were recommended for cancellation and levels between 8 and 9 g/dL advised for a single unit, if 2 or more units were requested. RBC transfusion rates were described as inpatient units per 1000 discharges to allow for interyear comparison. RESULTS: A downward trend in RBC transfusion was noted for the intervention period. Comparison of the baseline period with the past 3 years of the intervention period showed an approximate 33% decrease, which was highly significant (508 ± 66 vs. 341 ± 32, p < 0.01). Inpatient mortality rates declined over this period. CONCLUSION: Physician education in appropriate transfusion practice is desirable but may not greatly impact RBC use. Engagement of physicians who prescribe RBCs that appear inappropriate for indication or dose was associated with a significant decline in RBC use without evidence of a change in mortality.

Undernutrition and associated factors among hospitalized patients.

BACKGROUND & AIMS: The identification of modifiable risk factors associated with disease-related undernutrition at hospital admission will contribute to the development of integrated intervention and control strategies for a timely primary prevention. This study aim was to quantify the association between functional autonomy and undernutrition. METHODS: A multicentric cross-sectional study was developed in six public hospitals in Portugal. Undernutrition risk was assessed using Nutritional Risk Screening 2002, undernutrition status was classified from anthropometry and functional autonomy was evaluated using the Katz Index. RESULTS: In this sample of 1144 patients, 36% were at undernutrition risk and 9.7% undernourished. In logistic regression analysis, dependent patients were at an increased risk of undernutrition (OR = 1.69, 95% confidence interval (CI) = 1.20-2.39). The following parameters: illiteracy (OR = 2.45, CI = 1.52-3.96), age (one year increment) (OR = 1.03, CI = 1.02-1.04), male (OR = 1.61, CI = 1.19-2.16), single/divorced/widowed (OR = 1.83, CI = 1.34-2.51) and smoker (OR = 1.55, CI = 1.02-2.35) also increased the undernutrition risk. The impaired functional status, being single, divorced or widowed and be a smoker were also associated with anthropometric undernutrition. CONCLUSIONS: Functional impairment is related with undernutrition risk and with anthropometrical undernutrition at hospital admission. We also conclude that little extra information is gained by using anthropometrical indices compared to NRS 2002 when assessing the factors associated with undernutrition.

The economic impact of disease-related malnutrition at hospital admission.

BACKGROUND & AIMS: The reported frequency of disease-related malnutrition (DRM) for patients admitted to hospitals has been shown to be high, but an accurate estimate of the magnitude of its economic costs is lacking. The objective of this study was to determine the impact of DRM on hospitalization costs. METHODS: A probabilistic sample of 469 (50%) patients from two hospitals was recruited on a cross-sectional study. DRM was evaluated by the Nutritional Risk Screening-2002 instrument at hospital admission and hospitalization costs were calculated for each patient based on hospital length of stay and on the discharge diagnosis-related group (DRG) code. Estimates of the association between DRM and deviations from the mean cost within each DRG were carried out. RESULTS: Patients classified as nutritionally-at-risk accounted for 42% of the sample. Multivariate estimates of the determinants of cost deviation shows that the cost of treating a nutritionally-at-risk patient is 20% higher than the average of the respective DRG. Patients that are classified on DRG classes that have a higher relative weight are less likely to end up with hospitalization costs above the mean. CONCLUSIONS: Considering this sample case-mix, DRM can represent an increase in costs of 19.3%, or between 200 and 1500 euros, with a confidence of 95%.