Implementation of a Hospital-Wide Blood-Sparing Sampling Protocol and Changes in Blood Conservation, Transfusion Use, Costs, and Environmental Sustainability: A Pre–Post Quality Improvement Study
Manoel Iomar de Medeiros, Rodolpho Augusto de Moura Pedro, Giseli Rodrigues de Carvalho, Marina Costa Cavallaro, Juliana Jardim Bartocci, Erika Abdon Fiquene Oliveira, Helidea Lima, Maria Luisa do Nascimento Moura, Fernanda Rodrigues de Freitas, Thiago Gomes RomanoAbstract
Background
Diagnostic phlebotomy contributes to hospital-acquired anaemia and generates economic and environmental burdens. We evaluated changes in blood collection, transfusion use, direct tube-acquisition costs, and plastic consumption after implementation of a hospital-wide blood-sparing sampling protocol.
Methods
This retrospective pre–post cohort study compared the 12 months before and after implementation of a multicomponent intervention on 1 October 2024. The intervention combined smaller-volume collection tubes, consolidation of laboratory tests into fewer tubes, and monthly educational meetings promoting rational test ordering. The primary outcome was monthly blood volume collected per admitted patient. Process outcomes included total blood volume, blood volume per test, tubes per patient, and number of laboratory tests. Sample recollection was evaluated as a balancing outcome. Secondary exploratory clinical outcomes included packed red blood cell units transfused per patient, hospital and intensive care unit length of stay, and intensive care unit mortality. Direct tube-acquisition costs and plastic-related environmental estimates were also evaluated.
Results
The study included 24,094 admissions, comprising 8,513 in the pre-intervention period and 15,581 in the post-intervention period. Blood volume collected per patient was lower in the post-intervention period than in the pre-intervention period (26.6 vs 113.5 mL; P < 0.01), as were blood volume per laboratory test (0.61 vs 1.78 mL; P < 0.01) and tubes collected per patient (8.2 vs 22.7; P < 0.01). Sample recollection was also less frequent (0.4% vs 0.9%; P < 0.01). In the unadjusted analysis, the monthly ratio of packed red blood cell units transfused to hospital admissions was lower in the post-intervention period (0.07 vs 0.12; P < 0.01). Hospital and intensive care unit length of stay and intensive care unit mortality were similar between periods. The post-intervention period was associated with an estimated reduction of 1,001.0 kg in plastic consumption, corresponding to approximately 3,003 kg CO₂e, and direct tube-acquisition cost savings of US$9,609 over one year.
Conclusion
Implementation of the multicomponent blood-sparing protocol was associated with lower diagnostic blood collection, sample recollection, and lower monthly ratio of packed red blood cell units to hospital admissions. Because of the retrospective pre–post design, concurrent hospital expansion, and differences in case mix, the change in transfusion use cannot be causally attributed to the protocol or to any individual intervention component. The findings support further prospective evaluation of blood-sparing laboratory practices.