Key result
Bespoke change package linked to ~11-fold greater compliance with preoperative anemia and iron deficiency screening.
Why the study?
Implementation of pathways to screen surgical patients for preoperative anemia and iron deficiency remains limited.
Does a bespoke change package improve compliance with a preoperative anemia and iron deficiency screening pathway in surgical patients?
Does a bespoke change package improve compliance with a preoperative anemia and iron deficiency screening pathway in surgical patients?
Odds Ratio: 10.6 (95% CI 4.4–25.5)
p-value: p=< .000
Implementation of a bespoke change package significantly improved compliance with a preoperative anemia and iron deficiency screening pathway and yielded cost savings, though it was underpowered to show differences in clinical outcomes.
Improved compliance observed post-intervention; leaves open whether clinical benefits or cost savings hold in larger prospective trials.
BACKGROUND: Implementation of pathways to screen surgical patients for preoperative anemia and iron deficiency remains limited. This study sought to measure the impact of a theoretically informed, bespoke change package on improving the uptake of a Preoperative Anemia and Iron Deficiency Screening, Evaluation, and Management Pathway. STUDY DESIGN AND METHODS: Pre-post interventional study using a type two hybrid-effectiveness design evaluated implementation. Four hundred (400) patient medical record reviews provided the dataset (200 pre- and 200-post implementation). The primary outcome measure was compliance with the pathway. Secondary outcome measures (clinical outcomes) were anemia on day of surgery, exposure to a red blood cell (RBC) transfusion, and hospital length of stay. Validated surveys facilitated data collection of implementation measures. Propensity score-adjusted analyses determined the effect of the intervention on clinical outcomes, and a cost analysis determined the economic impact. RESULTS: For the primary outcome, compliance improved significantly post-implementation (Odds Ratio 10.6 [95% CI 4.4-25.5] p < .000). In secondary outcomes, adjusted analyses point estimates showed clinical outcomes were slightly improved for anemia on day of surgery (Odds Ratio 0.792 [95% CI 0.5-1.3] p = .32), RBC transfusion (Odds Ratio 0.86 [95% CI 0.41-1.78] p = .69) and hospital length of stay (Hazard Ratio 0.96 [95% CI 0.77-1.18] p = .67), although these were not statistically significant. Cost savings of $13,340 per patient were realized. Implementation outcomes were favorable for acceptability, appropriateness, and feasibility. CONCLUSION: The change package significantly improved compliance. The absence of a statistically significant change in clinical outcomes may be because the study was powered to detect an improvement in compliance only. Further prospective studies with larger samples are needed. Cost savings of $13,340 per patient were achieved and the change package was viewed favorably.
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Delaforce et al. (2023) studied Preoperative anemia and iron deficiency (n=400). Bespoke change package for preoperative anemia and iron deficiency screening pathway vs. Pre-implementation was evaluated on Compliance with the pathway (OR 10.6, 95% CI 4.4-25.5, p=< .000). A bespoke change package significantly improved compliance with a preoperative anemia and iron deficiency screening pathway compared to pre-implementation (OR 10.6; 95% CI 4.4-25.5; p<.000).
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