• The Korean Journal of Blood Transfusion
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• v.23 no.2
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• pp.136-144
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• 2012

Background: Fresh frozen plasma (FFP) transfusion is administered primarily for management of acquired bleeding disorders. However, in practice, FFP transfusion is increasing without a solid rationale. Methods: We conducted an audit to evaluate the appropriateness of the indications for FFP transfusion during the period from July 2010 through June 2011. Assessment of the appropriateness of the indications was based on the national transfusion guidelines and the transfusion criteria promulgated by the Severance Hospital. Results: In total, 17,733 units of plasma were transfused to 1,949 patients over 4,982 events. We found that administration of FFP was not in compliance with the recommended guidelines in 1,990 events. The number of total FFP transfusions was higher in medical departments (Gastroenterology) than in surgical departments (Thoracic and cardiovascular surgery, General surgery). However, the proportion of cases of inappropriate transfusion was higher in surgical departments than in medical departments. Both the total number of FFP transfusion and the proportion of inappropriate transfusion were high in patient with neoplasm, disease of the digestive system, and diseases of the circulatory system. Conclusion: Continuous monitoring on appropriateness for FFP transfusion and feedback to the physician are critical in securing the transfusion safety as well as maintaining the quality of FFP transfusion. New-found indication for FFP transfusion should be investigated and applied in timely manner.

• Korean Journal of Clinical Laboratory Science
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• v.54 no.1
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• pp.73-77
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• 2022

Blood products (BPs) can only be obtained through blood donation and hence represent a finite resource. BPs should therefore be used conservatively. However, BPs are being used indiscriminately without evidence. The purpose of this study was to evaluate the reasons for the use of BPs and their appropriateness. The investigation was carried out based on hemoglobin levels. Data were obtained from Nov 1, 2020, to Oct 31, 2021, from a hospital's OCS/EMR systems. The BPs were dispensed in 21,303 cases, and the number of hemoglobin levels >7.0 g/dL or higher among red blood cell drugs used by each treatment department was 1,173 (>7.0 g/dL). The misuse of blood transfusions is increasing social costs, with the adequacy of transfusion becoming increasingly important. Hence, each medical institution should review the transfusion guideline evaluation index, check the status of the release of BPs, and institute educational programs covering transfusion guidelines and continually evaluate their adequacy.

• Journal of Chest Surgery
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• v.57 no.4
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• pp.390-398
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• 2024

Background: In this study, we examined the impact of a patient blood management (PBM) program on red blood cell (RBC) transfusion practices in cardiothoracic surgery. Methods: The PBM program had 3 components: monitoring transfusions through an order communication system checklist, educating the medical team about PBM, and providing feedback to ordering physicians on the appropriateness of transfusion. The retrospective analysis examined changes in the hemoglobin levels triggering transfusion and the proportions of appropriate RBC transfusions before, during, and after PBM implementation. Further analysis was focused on patients undergoing cardiac surgery, with outcomes including 30-day mortality, durations of intensive care unit and hospital stays, and rates of pneumonia, sepsis, and wound complications. Results: The study included 2,802 patients admitted for cardiothoracic surgery. After the implementation of PBM, a significant decrease was observed in the hemoglobin threshold for RBC transfusion. This threshold dropped from 8.7 g/dL before PBM to 8.3 g/dL during the PBM education phase and 8.0 g/dL during the PBM feedback period. Additionally, the proportion of appropriate RBC transfusions increased markedly, from 23.9% before PBM to 34.9% and 58.2% during the education and feedback phases, respectively. Among the 381 patients who underwent cardiac surgery, a significant reduction was noted in the length of hospitalization over time (p<0.001). However, other clinical outcomes displayed no significant differences. Conclusion: PBM implementation effectively reduced the hemoglobin threshold for RBC transfusion and increased the rate of appropriate transfusion in cardiothoracic surgery. Although transfusion practices improved, clinical outcomes were comparable to those observed before PBM implementation.

• Korean Journal of Clinical Laboratory Science
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• v.55 no.1
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• pp.65-70
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• 2023

The effect of improvement by keeping the former as the priority was examined through an evaluation of the role of the blood transfusion management (BTM) division. This division manages the status of blood for transfusion, evaluates the adequacy of blood transfusion (EABT), monitors and responds to the occurrence of transfusion-related side effects, and performs other tasks necessary for BTM. Although the establishment and operation of the BTM division can lead to the efficient evaluation of transfusion adequacy, there are disadvantages in that it takes time for EABT and it is difficult for the staff in charge of the BTM division to evaluate the adequacy of all the blood. In the future, it is essential to introduce a BTM division and committee specific to Korean patients to implement safe and appropriate BTM in medical institutions, and to assist medical institutions in training their personnel.

• Journal of Information Processing Systems
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• v.18 no.3
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• pp.302-310
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• 2022

Efficient use of limited blood products is becoming very important in terms of socioeconomic status and patient recovery. To predict the appropriateness of patient-specific transfusions for the intensive care unit (ICU) patients who require real-time monitoring, we evaluated a model to predict the possibility of transfusion dynamically by using the Medical Information Mart for Intensive Care III (MIMIC-III), an ICU admission record at Harvard Medical School. In this study, we developed an explainable machine learning to predict the possibility of red blood cell transfusion for major medical diseases in the ICU. Target disease groups that received packed red blood cell transfusions at high frequency were selected and 16,222 patients were finally extracted. The prediction model achieved an area under the ROC curve of 0.9070 and an F1-score of 0.8166 (LightGBM). To explain the performance of the machine learning model, feature importance analysis and a partial dependence plot were used. The results of our study can be used as basic data for recommendations related to the adequacy of blood transfusions and are expected to ultimately contribute to the recovery of patients and prevention of excessive consumption of blood products.

• Korean Journal of Clinical Laboratory Science
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• v.36 no.2
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• pp.158-162
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• 2004

The over-preparation of blood for elective surgery causes some problems such as returning of blood, inefficient task and loss of reagents. In recent blood transfusion practice, there has been changing patterns of blood use in elective surgery as various side effects of transfusion have become known and operation techniques are developed. This study was performed to evaluate the optimal utilization of blood for various elective and/or emergency surgery. We surveyed the quantity of blood transmitted to wards, returned to blood bank, and the number of crossmatching test done for the elective surgery of the patients at the D. University Hospital, the tertiary teaching hospital from August 1, 2001 to October 31, 2001. Crossmatched to transfusion ratio (C/T ratio) was calculated, in which C means the unit of accomplished crossmatching test and T means the unit of transfused blood component. The unit of transfused blood was analysed in terms of issuing time, sex, age, clinical department, and blood component type. The usage of bloods for the emergency surgery was also analyzed. In our study, C/T ratio was highest on Monday (1.54) and Tuesday (1.53), and higher in female patients(1.54) than in male patients (1.32). No significant relationship was observed between age groups. Among clinical departments, thoracic and cardiovascular surgery showed the highest C/T ratio (1.54). From above results, we could be sure that the management of transfusion practice was relatively appropriate in recent years, although the entire introduction of type and screen (T&S) method was desirable. If the T&S method is performed, the C/T ratio would be almost 1.00 and it would also relieve the duty of blood bank.

• Journal of Korean Academy of Nursing Administration
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• v.13 no.2
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• pp.199-207
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• 2007

Purpose: Clinical characteristics and medical cost were analyzed according to the surgical procedures for intertrochanteric fracture in aged patients to assess the appropriateness of treatment expense and to find possibility of reducing the medical cost. Method: Variable for the statistical analysis were; the clinical characteristics, medical cost according to the surgical procedures, the treatment success rate, the total medical expense, and the average expense per case. SAS Package Version 8.02. was used to analyze the relevant data. Results: Operative procedures differ significantly according to the gender and by the location of institution. Only significant clinical variables according to the operative procedure were duration of general anesthesia and amount of blood transfusion. Average cost per treatment was the highest in the bipolar hemiarthroplasty followed by the gamma nail and hip compressing screw. Average cost for bipolar hemiarthroplasty was significantly higher than other surgical procedures. Conclusions: The difference in hospital costs for treatment of intertrochanteric fracture originates from the utilized surgical procedures, mostly by the materials used. The method of surgical treatment should be carefully determined by the purpose of the surgery, in order to improve the quality of medical care and also to reduce the hospital cost.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.75-82
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• 2010

Purpose: In Korea, trauma is the $3^{rd}$ most common cause of death. The trauma treatment system is divided into pre-hospital and hospital stages. Deaths occurring in the pre-hospital stage are 50% of the total death, and 20% of those are deaths that are preventable. Therefore, the purpose of our study is to calculate the preventable death rates caused by trauma in our current pre-hospital system, to analyze the appropriateness of the treatment of traumatized patients and to draw a conclusions about the problems we have. Methods: The study was done on traumatized patients who expired at the emergency department from January 1, 2005, to December 31, 2009, at the Korea University Medical Centers in Anam, Guro and Ansan. The data on the patients were reviewed retrospectively based on characteristics, conditions on admission and trauma severity. The patient's RTS (revised trauma score) and ISS (injury severity score) was calculated. Preventable death rate was calculated by TRISS (the trauma score-injury severity score). Results: A total of 168 patients were enrolled. All patients were intubated and underwent CPR. Of the total, 72% patients were male, and traffic accidents were the most common form of trauma (52.4%), falls being second (28.6%). Head injury, solitary or multiple, was the most common cause of death (55.4%). Thirty-eight (38, 22.6%) deaths were preventable. The 22.6% preventable death rate consisted of 15.5% potentially preventable and 7.1% definitely preventable deaths. Based on a logistic regression analysis, the relationship between the time intervals until transfusion and imaging and death was statistically significant in the hospital stage. In the pre-hospital stage, transit time from the site of the injury to the hospital showed a significant relationship with the mortality rate. Conclusion: One hundred sixty-eight (168) patients died of trauma at the 3 hospitals of Korea University Medical Center. The TRISS method was used to calculate the preventable death rate, with a result of 22.6%. The only factor that was significant related to the preventable death rate in the pre-hospital stage was the time from injury to hospital arrival, and the time intervals until transfusion and imaging were the two factors that showed significance in the hospital stage. Shortening the time of treatment in the field and transferring the patient to the hospital as quickly as possible is the most important life-saving step in the pre-hospital stage. In the hospital stage, the primary survey, resuscitation and diagnosis should proceed simultaneously.